AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. January 2005, Volume 7, Number 1.

Module 1

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Case 1.1: Potential Patients—A Call from the Emergency Department

Option Assessment

A.  

Telling the emergency room physician that he has never seen Harry Jones and therefore cannot take responsibility for him is an acceptable action according to the Code. Regarding the acceptance of potential patients, Principle VI of the AMA Principles of Medical Ethics states: "A physician shall, in the provision of patient care, except in emergencies, be free to choose whom to serve…." This basic principle is reconfirmed in Opinions 10.05, "Potential Patients," 9.06, "Free Choice" and 8.11, "Neglect of Patients." The opinions state that physicians have the "prerogative to choose whether to enter into a patient-physician relationship."Because other physicians are meeting Mr. Jones's emergent needs, Dr. Stevens has no specified obligations to Mr. Jones.

B.

Informing the emergency room that Harry Jones is in fact his patient is the preferred option because Dr. Stevens has already indicated that he will accept Dr. Kale's patients. This option is also supported by the Code in Opinion 8.11, "Neglect of Patient:" "Once having undertaken a case, the physician should not neglect the patient." Whether or not Dr. Stevens has undertaken the care of Mr. Jones can be disputed, but Mr. Jones is already operating under the presumption that Dr. Stevens is his doctor.

C.

The emergency nature of the situation complicates the issue of what Dr. Stevens "should" do. Agreeing to consult during the emergency situation while not becoming Mr. Jones's primary care physician is acceptable. Opinion 10.05 (4), "Potential Patients" states that "greater medical necessity of a service engenders a stronger obligation to treat."Dr. Stevens' familiarity with Mr. Jones's medical history is such that Mr. Jones's medical treatment may be substantially improved by Dr. Stevens' involvement.

D.

The prerogative of the physician to decline a patient is not absolute. HIV status is not a sufficient reason to decline a potential patient, thus this option should be avoided. Opinion 10.05 (2b) states "physicians cannot refuse to care for patients based on race, gender, sexual orientation or any other criteria that would constitute "invidious discrimination." Nor, according to Opinion 2.23, "HIV Testing," can a physician discriminate against patients with infectious diseases or HIV seropositivity: "It is unethical to deny treatment to HIV-infected individuals because they are HIV seropositive."

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