section Tk practice partner
When Values Clash
Bridging the divide if you disagree with patient choices
DOC TALK
By Stuart Foxman illustration: sandy nichols
An exam room isn’ t a courtroom. For doctors, the goal is to help patients, not judge them.“ You don’ t need to share the patient’ s values, goals and world views – but you should respect their right to hold them,” says Dr. Jennifer Gibson( PhD), director of the Joint Centre for Bioethics, University of Toronto. Feelings can become heated. One bioethicist tells of a doctor who, upon being asked about an abortion, rebuked the patient:“ You’ ll burn in hell.” Big moral debates in medicine focus on controversial issues like, most recently, physician-assisted death. Yet beyond matters of religion or conscience, value judgments occur routinely across health care. Bioethicists tell other stories too, about doctors who criticize choices their patients make. Like doctors who admonish patients who smoke or who fail to immunize their children.“ The research base leaves no doubt that clinicians make moral judgments of their patients … not only in egregious cases but also in everyday situations,” concluded a review in the journal Philosophy, Ethics, and Humanities in Medicine( 2010). The article called the problem“ pervasive”, yet stated that“ the role of moral judgment is largely unrecognized in the literature on healthcare communication, caring, empathy and trust.” We all have our values and bring them to any encounter. That’ s human nature. The expectation though is to remember your professional obligations to your patients and to ensure that your own values do not impact patient access to care.
Issue 1, 2017 Dialogue 31