feature
of Medicine article entitled
“No Appointment Necessary?
Ethical Challenges in Treating
Friends and Family.”
When emotional and
clinical objectivity
are compromised,
physicians may have
difficulty meeting the
standard of care
Back to Basics
It is important to return to
basic principles to carefully consider the risks
in treating people for whom physicians have
a strong emotional attachment. The practice of medicine relies on the foundation of
the physician-patient relationship. Consent,
confidentiality and privacy solidify the foundation and are prerequisites to quality care. What
happens to these values when physicians bring
their own emotions into play?
In the case of treating a minor condition or
an emergency, the associated risks are either
minimal or are outweighed by the benefits of
providing treatment. However, providing treatment beyond these circumstances gives rise to
a physician-patient relationship, and the lack
of informed consent, the potential for bias and
undue influence, as well as the lack of medical documentation makes treating loved ones
potentially hazardous.
In our revised draft policy, Physician Treatment of Self, Family Members and Others
Close to Them, which is now out for external
consultation, the College takes the position,
based on research and professional ethics
articles, that there a number of ways that compromised objectivity can manifest itself.
A physician may unconsciously hold preconceived notions about the individual’s
health and behaviour, or make assumptions
about his or her medical history or personal
circumstances. Similarly, the physician may
assume that he or she is privy to all the relevant
information and that taking a full history or
conducting a medically indicated examination
10
Dialogue Issue 2, 2015
is therefore unnecessary. For
example, a physician providing treatment for his or her
child may assume the child
has not engaged in sexual
activity or high risk behaviour, and therefore may not
consider all of the possible clinical indications
for treatment.
And when emotional and clinical objectivity are compromised, physicians may have
difficulty meeting the standard of care. This
can occur in a number of ways, including, but
not limited to:
• hysician discomfort in discussing sensitive
P
issues or taking medical histories;
• iscomfort amongst family members and
D
others close to the physician in discussing
sensitive issues with the physician. This can
be especially true with children receiving
treatment, and particularly with respect
to sexual health and behaviour, drug use,
mental health issues, or issues of abuse or
neglect;
• ressure on physicians to treat problems
P
that are beyond the physician’s expertise
or training, or to prescribe drugs to family
members that are addicting/habituating;
• hallenging for the physician to recognize
C
the need to obtain informed consent in
this context and to respect the individual’s
decision-making autonomy;
• ifficulty for the physician to recognize
D
that the duty of confidentiality applies
in this context, just as it would for any
patient. The physician may also experience