February 28, 2024

Treating racist patients

Should hospitals accommodate them? Should doctors?

Here’s an interesting ethical conundrum. How should a doctor respond if he or she is rejected because a racist patient rejects them? An article in the latest issue of the New England Journal of Medicine  opens with this confronting scenario:

A 77-year-old white man with heart failure arrives in the emergency department of an urban hospital at 3 a.m. with shortness of breath and a fever. When a black physician enters, the man immediately announces, “I don’t want to be cared for by a %$#!{& doctor!” Taken aback, the physician retreats from the room. She’s offended by the man’s rejection and demeaning language — but knows that he may have a serious medical condition and that she cannot treat him against his will. How should the physician proceed?

The authors suggest that encounters like this may become more common as the United States becomes more ethnically diverse. It is a tricky situation, because the patient has a right to refuse medical care, including care from a unwanted doctor. On the other hand, health care workers have a right not to be discriminated again. Nurses have successfully sued hospitals which required them to accommodate patients’ prejudices. Doctors, however, have not brought lawsuits, as their employment conditions are different.

The authors have created a template for examining the practical and ethical issues raised by these cases: “the patient’s medical condition, his or her decision-making capacity, options for responding to the request, reasons for the request, and effect on the physician”. They conclude:

Although institutions should not accommodate, for individual physicians the decision to accommodate may be sound when the accommodating physician is comfortable with the decision, employment rights are protected, and the decision does not compromise good medical care.

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