Some of the central ethical dilemmas in healthcare involve the balancing act of acknowledging the rights of patients, resident physicians and clinical staff.
These dilemmas may stem from any number of conflicts between cultural beliefs, institutional principles and personal views. Complicating things further, there's also some controversy regarding whether the wishes of patients or clinicians should take precedence in clinical care.
In her talk "Ethical Dilemmas in Healthcare: Respecting the Rights of Patients, Residents, and Employees," now available for CME credit through AudioDigest, Dr. Rebecca Twersky reviews some cases where accommodations may be necessary in order to respect the rights of these three parties.
The intricacies of respecting patient rights
In her discussion of ethical dilemmas in healthcare, Dr. Twersky highlights an important example of patient rights: requests to refuse an exam by any persons on the medical team. These requests often come into conflict with the educational environment of academic medical centers.
While patients may request to have persons of a particular gender not be involved in their care due to religious beliefs, this may not be possible because of the rotating schedules of clinicians in the hospital. However, every effort should be made to respect the patient's rights. Patients also have the right to be made aware of those who will be involved in their care, from attending physician to resident to nursing staff.
That said, though patient preference based on deeply held beliefs must be acknowledged, the right of a resident physician to learn without discrimination must be respected, too.
The clause that protects resident rights
Dr. Twersky's review of a resident's rights illustrates another of the healthcare dilemmas in the learning environment of residency. If a resident feels discriminated against - particularly if this discrimination prevents their educational growth - there is some recourse in the form of Title IX. This federal civil rights law protects residents when they are in training.
As Dr. Twersky discusses, this protection from discrimination is predicated upon the characterization of hospitals as educational centers where residents are the students. While they are in training, they are also still members of the hospital's clinical staff, and as such, they may have the additional right to refuse to provide services that go against their own beliefs.
Accommodating hospital employee rights
Hospital employees' right to refuse to be involved in care that goes against their religious beliefs can present an additional dilemma for patients.
This has most often come up with abortion care, but the issue could also arise with contraception prescription. While this decision by hospital employees is protected, it poses the additional problem of who will then provide those necessary services. There may not be a surplus of physicians or other staff who can provide those services instead. Dr. Twersky notes, however, certain key aspects of employee rights have been recently protected by the current presidential administration.
Respecting the rights of every person involved in medical care requires a delicate balance. The common denominator in all situations? Do no harm.