Should doctors be able to turn patients away if they disagree with their lifestyle choice?

The article reads like many pregnancy stories. The happy couple finally become pregnant against all odds and eagerly anticipates the birth of their first child. This story, however, takes a twist that many people, including doctors, find hard to fathom.

In this case, the expectant mom is a transgender male, recognized as a male by law.

Thomas Beatie was born a female but made the decision to pursue sex reassignment. He underwent chest reconstruction and testosterone therapy, but stopped short of removal of his female organs. Two years ago he and his wife, who is unable to bear children herself, made the difficult decision that Thomas would be the one to carry their child. He stopped taking testosterone and, within four months, was experiencing normal female cycles.

What began then was a battle to find a doctor willing to take on their unusual situation. Thomas explains,

In total, nine different doctors have been involved. This is why it took over one year to get access to a cryogenic sperm bank to purchase anonymous donor vials, and why Nancy and I eventually resorted to home insemination.

There are many other stories out there. Perhaps they are not as controversial as Thomas’s story, but the underlying issue is the same. Should physicians be able to refuse treatment to a patient based on their negative perception of the patient, or the values they ascribe to them?

There have been many cases reported of doctors refusing to prescribe birth control, anesthesiologists refusing to take part in sterilization surgery, and, of course, the ever popular abortion debate.

In a study published in The New England Journal of Medicine, 63% of doctors said that they felt it was acceptable to tell patients they have moral objections to treatments, and 18% felt they had no obligation to refer these patients elsewhere.

Patients who are refused treatment are not likely to complain; they quite often feel humiliated but simply seek care elsewhere and put the episode behind them. They don’t often have the opportunity to complain to as wide an audience as Thomas did.

The problem with the physician’s right to refusal to treat patients who do not adhere to their own moral compass is that lines can become blurred. Take the following example:

A mother and her daughter were turned away from a doctor’s office because the mother had a visible tattoo. The doctor claimed he was a Christian and that he was simply creating a Christian atmosphere for his patients.

What is disturbing about these stories, extreme as they may seem, is that once discrimination is allowed against one group, it becomes easier to discriminate against another.

References

Beatie T. Labor of Love. The Advocate. April 8, 2008.

Curlin, F.A., Lawrence, R.E., Chin, M.H., Lantos, J.D. (2007). Religion, Conscience, and Controversial Clinical Practices. New England Journal of Medicine, 356(6), 593-600. DOI: 10.1056/NEJMsa065316

Erdely SR. Doctors’ beliefs can hinder patient care. MSNBC. June 22, 2007.

Christian pediatrician denies child service because parents are tattooed. Evangelical Right. February 16, 2007.