Aug. 6, 2019
I work for a public medical system, and we have an ethics seminar each month. The last one featured an article by a doctor in one of our hospitals. She discussed patients or their families who insist on having medical providers who are some combination of straight, white, male and/or American-born.
Some seminar participants thought patients should be able to choose such a provider in our system because they can do so in the private care system and because we now encourage them to use the private system if they prefer.
I was shocked that any providers considered it ethical to support patients’ openly making health care decisions based on bias. The point was also made that treatment is often provided in emergency settings where a patient’s life is at stake. Many of our treatment options are aimed at small populations of patients, so there may be only one practitioner available. That practitioner may not be male, straight, white or American-born. Patients cannot receive some types of specialty care outside our system, so they do not have the option of shopping around for all types of medical care. Is it truly ethical for patients to demand that their bigotry dictate who treats them? Name Withheld
Is it ethical for patients to want their bigotry to be accommodated? That’s an easy question: no, because expressing bigotry isn’t ethical. The harder question is whether health care professionals ought to accommodate their bigotry.
Everyone knows that doctors must not discriminate on the basis of gender, sexuality, race, religion or national origin when they select or treat patients: It’s an obligation they accepted when they entered the health care profession. (That doesn’t mean they have to take all comers; they can turn away patients for various other reasons.) But should patients be able to choose clinicians on the basis of such attributes? The answer is: It depends.
In an outpatient setting — in private care, as you note — patients can freely discriminate in choosing whom they want to treat them. That may be unethical as a matter of personal conduct, but we don’t want a system that would try to sift through their motives and correct for invidious ones. We’re in the Zocdoc era — something like Tinder M.D. Patient-consumers, in this context, have the prerogatives enjoyed by suitors to make choices that are biased and boneheaded.
The picture changes when we’re in an institutional setting, one in which patients haven’t chosen their health care practitioner. The picture changes when a man with a swastika tattoo, say, announces that he doesn’t want a black nurse touching his newborn in the neonatal intensive care unit. (That’s a real case, from a hospital in Flint, Mich.) He’s not obliged to choose a particular hospital. But once he has, a hospital that accommodates his request and assigns employees on that basis is effectively instituting his bias.
Your own medical system should be careful not to make that mistake. There are more complicated cases, to be sure. What about a woman who, as a survivor of sexual assault, asks to be seen by a female gynecologist? Here, surely, it would be reasonable to try to accommodate her, not least because the choice doesn’t reflect disrespect for male doctors, as refusing to be touched by an African-American nurse does reflect disrespect for black medical staff. Not every form of discrimination is invidious. It’s perfectly appropriate for a patient who speaks Spanish to ask for a doctor who does, too. It’s a very different thing for patients to reject a doctor because she also speaks Spanish.
For health care professionals who work in hospital systems, incidents of patient bias can be wounding. That’s why hospitals should, when possible, try to accommodate staff members who don’t want to be assigned to patients who display bias toward them. A doctor’s primary concern is the best care of her patients, and we rightly hold physicians to a higher bar than we do patients. But a health care system has to attend, as well, to the welfare of its staff members.
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