Care for the belligerent patient debated in AMA open forum

Input was also sought on the ethics of charging for nonmedical services.

By Bonnie Booth, AMNews staff. Jan. 5, 2004.

Honolulu -- As the AMA Council on Ethical and Judicial Affairs puts together its upcoming reports on several topics ranging from care of belligerent patients to fees and other surcharges for nonmedical services, it will have a wide range of opinions to take into account.

Dozens of doctors stepped forward to express their views during the council's open forum at the AMA House of Delegates meeting here in December 2003.

CEJA members were looking to their colleagues for input on whether the AMA Code of Medical Ethics' obligation to respond to medical emergencies to the best of their ability extended to the belligerent or inappropriate patient.

"The first questions should be what is the cause," said Mike Williams, MD, a neurologist from Baltimore and a delegate for the American Academy of Neurology. "Is the belligerence a manifestation of the patient's disease? If it is, then the obligation becomes higher."

Clifford Moy, MD, a Texas delegate and a psychiatrist from Austin, Texas, asked CEJA to consider redefining belligerence into two categories.

"Not all physical violence is the result of a treatable illness," he said. "I don't believe physicians are obligated to take undue risks. But if someone is verbally offensive or obnoxious, I do believe there is an ethical obligation to continue treating, as unpleasant as that is."