Nearly all of us who enter the medical field do so with the main intention of caring for others. We often also have secondary motivations—a love for science, an innate curiosity about how our bodies work, a small degree of masochism—but at our core, many of us just want to help people. That desire to care is not limited to people like ourselves; we care for all, regardless of race, religion, or ideology.
This is most obvious in emergency situations when instincts take over. When a patient arrives in critical condition, it doesn’t matter if they’re a sweet old grandma or domestic abuser with swastikas tattooed down their chest; we will do our best to save their lives all the same. But are there ever situations in which a medical professional should recuse themselves from care of a patient?
There are obvious situations in which the patient is a family member or you are not medically qualified to help the patient—no one would expect your significant other to be your patient or for a dermatologist to fix a fractured femur. In these cases, you pass on care to someone else. This is seen as completely acceptable and in line with the modern Hippocratic Oath: “I will not be ashamed to say ‘I know not,’ nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.”
Now consider non-life-threatening situations in which the patient’s ideology might impact your ability to care for them based on your own views. For example, take caring for the sweet old grandma and the domestic abuser again. This time, instead of a critical care situation, they are both coming in for consultations for a quality of life procedure, such as a knee replacement or cosmetic surgery. Do you believe that your ability to care for these patients will be completely uncompromised? And if you believe you have any sort of bias towards this patient, do you have an ethical obligation to pass care of that patient onto another physician who doesn’t? Though this may be within your area of expertise, if you are not able to utilize your skills on the basis of your ethics, does this still fall under the Hippocratic Oath and needing to “call in [your] colleagues when the skills of another are needed for a patient’s recovery”?
And if this is the case, where do you draw the line? Or are you allowed to recuse yourself from care of people based on their sexual orientation or is it right to not prescribe contraceptives if it goes against your own personal ideologies? Historically, courts have sided with medical professionals in these situations where they have been fired or reprimanded when they refused to provide care if it violates their principals [1].
Or is it simply our duty, as health care professionals, to look past any of our own beliefs regardless of which end of the spectrum they fall on—to respect patient autonomy and provide them with the best possible care in both life-threatening and routine situations? Is this not something we agreed to, setting aside our personal principles in service to our patients, when we first donned the white coat?
[1] Erdely, S., 2020. Doctors’ Beliefs Can Hinder Patient Care. [online] msnbc.com. Available at: <http://www.nbcnews.com/id/19190916/ns/health-womens_health/t/doctors-beliefs-can-hinder-patient-care/> [Accessed 11 July 2020]
Arjun Johal is a member of The University of Arizona College of Medicine – Phoenix Class of 2023. He graduated from the University of California at Santa Barbara in 2016 with a major in Biochemistry and a minor in English. In his free time he enjoys anything that gets him moving, whether it be a bicycle, a surfboard, or anything in between. He also welcomes discussion on topics of all ranges, ideally over a cup of tea. Feel free to contact him at arjunjohal[at]email.arizona.edu