Health & Healthcare

Should Doctors Be Allowed To Refuse Treatment?

May 25, 2008 | By Jennifer Bunn, RN | Share, Save, and Bookmark | 9 Comments

Health and Healthcare Category 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.

Himself herself 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.

Tags: care, child, choice, Christian, decision, discrimination, Doctor, lifestyle, mother, patient, patient selection, testosterone, Thomas Beatie, treatment

9 Comments

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Dan Abshear
May 25, 2008 | Permalink

Great article.

I was a medic in the military, but am not a doctor, but am a health care system educator

As far as the moral obligations issue, you have to realize that it is a big world, with cultures that perceive morals differently than those in the United States. Sex reassignment, however, is a lifestyle choice, like breat augmentation. So yes, doctors can ethically refuse to obligate such requests with certain patients seeking such procedures. However, in most other cases, I believe doctors are obligated to treat thier patients, regardless of thier socioeconomic status, morality, religion, and so forth. Doctors, ideally, strive to cure or treat, objectively and accurately. In other words, and for example, if I was a doctor working in an emergency department and a murderer arrived with a broken arm, as a doctor, you are obligated to treat this patient. It’s a requirement of the ethics of their profession.

Dan Abshear

Jennifer Bunn, RN
May 25, 2008 | Permalink

Dan,
Thanks for your comments. I agree with you. As a nurse I have had many oppoprtunities to come in contact with a wide variety of patients. Although I may not always agree with their choices or the way they live their lives, my job is to help them recover, no matter what my personal opinion of them may be. This is difficult sometimes, but comes with the territory as a health care professional.
Sincerely,
Jennifer

Hazumu Osaragi
May 25, 2008 | Permalink

Dan;

“Lifestyle choice?” Not! ‘Morals’ do not enter into this. For sufferers of Gender Disphoria (the medical term for the feeling that ones’ gender is not in congruence with the sex of their body, they can hold off for a period of time because of shame and the intense pressure a small minority of society place on those who fall outside the set called ‘normal’. We all want to fit in, and it’s terrifying to be perceived as different, much less in some way icky.

I’m reasonably certain, Dan, that you believe that children are born blank slates, ‘Tabula Raza’, and that parents patiently teach all the good stuff (including behaving in a manner congruent with the societal roles mandated for those possessing male or female genitalia,) and try to preserve the primordial innocence babies represent by shielding them from all the bad, bad ideas the big bad terrible world has.

Would you agree that children have to be taught how to behave in a gender appropriate manner? Then please explain what happened to David Reimer, the infant whose penis was destroyed in a botched circumcision and was surgically altered to be a girl? It didn’t take. Was David Reimer ‘gender confused’? He had surgically constructed sensate female genitalia that were distinguishable from ‘normal’ female genitalia only by experts. He had a closet full of dresses (which he refused to wear), a toy box full of barbies and other girl toys (which he refused to play with,) and parents who desperately tried to train him to be a girl. They called him confused. They force-feminized him. It didn’t work.
Was refusing to accept the gender role his parents, at the direction of John W. Money, Ph.D, a ‘lifestyle’ choice he made?

You will say, “Of course, he was born a boy, and he will always be a boy.” But he was given female genitalia and raised as a girl! Or is it something else? Chromosomes? That’s not 100%. There are XY females and XX males, as well as XXY,XYY, XXX and XO variations. Are having those variations ‘lifestyle choices’?

Did I make a ‘lifestyle choice’ to have my mother’s OBGYN prescribe her Diethylstilbesterol (DES), a synthetic estrogen shown to feminise 20% of male babies whose mothers took it in the first trimester. What kind of conservative drivel will you spew at me for finally, finally figuring it out and transitioning to the gender role that matches my feminised brain? I’m glad I have found medical professionals who have found my condition to not be a moral failing on my part, nor a ‘lifestyle choice’, but a medical problem requiring medical intervention.

Hazumu Osaragi

Wolfgang E. B.
May 25, 2008 | Permalink

Dan Abshear wrote,

Sex reassignment, however, is a lifestyle choice, like breat augmentation.

Actually, transsexualism is a neurological intersex condition, and sex reassignment is the proven medical treatment for its sufferers. It’s more like having a painful tumor removed than breast augmentation.

Three Ears
May 26, 2008 | Permalink

Great post!

Barbara C Phillips
May 30, 2008 | Permalink

As a Nurse Practitioner in private practice, this is a question I often have to answer for myself.

Is it okay to turn away or discharge a patient? Under what circumstances? Am I discriminating when I tell the obviously impaired individual that I am unable to help them? What about the angry 6 foot tall man who is yelling in the waiting room? How about the schizophrenic diabetic who is insisting that the Pope will save him and my medicines are killing him? And then what about the person who is over 600lbs? Am I discriminating when I tell her I cannot help her (none of my equipment will accommodate her size)? And of course, what about for lack of payment?

My practice is very diverse in terms of individual with various sexual orientation, gender, educational levels, ethnic backgrounds, and religious preferences. We see folks who fall at various points on the economic and mental health scales. We happen to believe that a woman has the right to choose abortion, but also feel we have the obligation to teach prevention.

Yet, I have to say, I do reserve the right to treat someone based on the capabilities of my skills and knowledge, safety factors, and to be honest, the hassle factor comes into play. We can only do so much.

It’s great to see these kinds of questions come out of the closet and into full daylight. Thanks!

Barbara C. Phillips, NP

Tom Rees
September 24, 2008 | Permalink

What about refusing to treat blacks or jews? If physicians are providing a public service, then they should perform according to the agreed standards of that public service. That includes not opting out of treating people because of your beliefs - and religious beliefs should not be privileged in this regard. If you are racist, sexist , homophobic or otherwise falling down on generally accepted principles, then keep it at home or get a different job.

Same applies to other public servants, e.g.: http://www.humanism.org.uk/site/cms/newsarticleview.asp?article=2468