Requests by patients can put doctors in ethical bind

When confronted with patient demands that can result in discrimination, physicians can look to their hospital ethics committee for help in making a decision.

By Vida Foubister, AMNews staff. Jan. 22, 2001.

A Nashville heart surgeon publicly apologized last month for granting a patient's request to keep men, specifically black men, out of the operating room during her surgery.

Michael Petracek, MD, told The Tennessean that he made this decision because he believed that the patient's husband "probably wouldn't let her have the operation" unless he accepted their condition. The patient had a potentially life-threatening cardiovascular disorder, and another local doctor had already declined to alter hospital staffing to meet her stipulations.

Though patient requests such as this are thought to be quite common, especially in home care situations, the medical profession doesn't have a specific policy telling physicians how to deal with them. Instead, the AMA's Code of Medical Ethics emphasizes that physicians "may not decline to accept patients because of race, color, religion, national origin, sexual orientation or any other basis that would constitute invidious discrimination."

Patients, on the other hand, aren't bound by the same obligations. They are free to choose their caregivers based on discriminatory characteristics such as race. "It's wrong for a patient to do that, but patients can be wrong and we can't write guidelines for patients," said Herbert Rakatansky, MD, chair of the AMA's Council on Ethical and Judicial Affairs.

Furthermore, there are some instances where society accepts discrimination based on a caregiver's personal characteristics.

"Most obstetrics programs are used to having [family members of] Muslim patients say, 'I don't want any male doctors for my wife,' or the patient herself will say that," explained Kate Payne, RN, a clinical ethicist at Saint Thomas Hospital, where Dr. Petracek performed the Oct. 9, 2000, open-heart surgery. "We will try to meet that requirement, but in an emergency, the only doctor available may be a man." [...]