Transcript Conscience in the Clinic: When Patient Requests and Physician

Conscience in the Clinic:
When Patient Requests and
Physician Ethics Conflict
Matthew A. Allison, MD, MPH
Assistant Professor
Family and Preventive Medicine
Ethical Theories
Normative Ethical Theory

A principle that can be used to decide
what morally ought to be done and the
rationale supporting it
Bayes M and Henley K. Right Conduct: Theories and Applications. 1983. Random House, New York.
Egoism

One always ought to promote one’s own
interest, as the only rational basis for
deciding what to do.

Without considering the interests and values
of other people
Subjectivism

Moral judgements are simply expressions
of personal preferences

“matter of opinion”
Skepticism

Moral judgements can never be known to
be true

That is, there simply is no such thing as
knowing that an action is right or wrong
Relativism

The validity of moral judgements are
relative to some authority

For example, society is the absolute moral
authority
Utilitarianism

Morality depends solely on the
consequences (ends obtained) of the
conduct
Natural Law

The rightness of an action is determined
by reference to nature rather than to
convention, custom or preferences

In this case, nature = human nature guided
by rational thought
Ethical Decision Making
Rights vs. Responsibilities
Rights

A valid claim or entitlement that a person
can make to restrict the conduct of others
in their dealings with him/her

If there are no other conflicting moral
obligations, it is obligatory to respect and
individual’s rights
Rights

Types

Positive


Directly providing assistance for the holder of the
rights
Negative

Not interferring with the rights of the holder
Responsibility

The sense in which one is responsible for
achieving (or maintaining) a good result in
some matter.

“Obligations”
Case
Case

You are the resident physician in an OB/GYN
clinic seeing patients for urgent care
services. The current case is a 17 year-old
female accompanied by her mother. The patient
presents with dysmenorrhea during her last
period. Specifically, she had very little menses
and associated lower abdominal cramping. This
was 2 months ago. You ask additional historical
questions and then state that you would like to
do a physical examination. She asks that this
examination be done without her mother
present.
Case (cont)

As you begin the examination, the patient states
that she did a pregnancy test two weeks ago,
which was positive. She communicates that
this is the result of a "one-night stand" and that
she does not want to approach the man who
fathered the child. She also does not want her
parents to know about this and therefore asks
for an abortion to be performed. She insists
that this procedure be kept strictly confidential
(even to the point of not telling your attending
physician).
Case (cont)

Of note, you have been certified to
complete abortion procedures
independently. Although you are not an
overly religious person, it is your ethical
belief that performing some abortions is
unacceptable.
Question #1

Are you ethically or legally obligated to
inform the patient's mother of her
daughter's pregnancy?
Question #2



Must you consult with your attending
physician (against the patient's wishes)?
What do hospital rules and professional
ethics require here?
What do you tell the patient?
Question #3


If a physician believes abortion in these
circumstances would be morally wrong,
what are his or her legal and professional
obligations?
Are you legally or professionally bound to
refer the patient to another physician for
abortion services?
Question #4

How in this situation and others like it can
you best reconcile personal ethical
principles and the welfare of your patient?