Earlier this summer there were several stories that appeared in the news about physicians who allegedly refused to provide certain non-emergency treatments (e.g., artificial contraception) on religious or moral grounds[1]. Consequently, the College of Physicians and Surgeons of Ontario (CPSO) undertook a review of its Physicians and the Ontario Human Rights Code policy and invited the general public to weigh-in on whether doctors should be permitted to deny patients specific treatments or procedures if they conflict with the doctors’ beliefs. The Ontario Human Rights Commissioner also expressed a keen interest in this matter, as it potentially means that patients may be unable to access care because of race, age, ethnicity, gender, sexual orientation, or disability.
This issue of providing patient care or not when it conflicts with our own personal values is not as pressing a concern in RT practice, as we are generally not the health care professionals proposing plans of care. However, I suspect many of us have been in situations where we were asked to do something that was contrary to our belief system. For example, it may have been a circumstance where we felt a terminally-ill patient should be withdrawn from life support, while the family insisted that all possible medical interventions be continued. Although we may believe it’s cruel to subject a patient to painful, invasive procedures when there is – in our opinion – little chance of recovery, the family may believe life to be so sacred that it must be preserved at all cost. Values collide – but there is still a patient that requires care.
Even beyond objecting to the treatment itself, our belief system can cause us to make judgments about what “type” of people are worthy of the care that we provide. I recall being involved with managing ventilation on an alcoholic individual recovering from the most recent of several liver transplants, and I questioned why he deserved another chance if he could not stop drinking. I felt it was wrong to “waste” an organ when there is such a shortage and so many other people in need. Did it change the way I provided his care? I don’t think so. I hope not.
Some of the people expressing opinions on the physicians’ issue have stated that doctors must leave their personal beliefs at home, as they have no place in medical practice. Yet I question whether this is possible for any health care professional? What we believe and what we consider to be most important in life are the things that make us who we are, and we just can’t park that at the door of the patient’s room. It isn’t as simple as saying “it’s not about you”, because you and what you believe are an integral part of the patient-health care professional relationship. The best any of us can do is to recognize that our core values and beliefs are constantly at play, and they have the potential to shift our focus inward and away from the patient who needs and deserves our full attention.
The CRTO’s Commitment to Ethical Practice document offers some insight into how our belief system impacts us both personally and professionally, as well as guidance on the integration of our values with our obligations as health care professionals.
[1] Grant, Kelly. (2014, July 2). Policy allowing doctors to deny treatment on moral or religious grounds under review. Globe and Mail. Retrieved from http://www.theglobeandmail.com/life/health-and-fitness/health/policy-allowing-doctors-to-refuse-treatment-on-moral-or-religious-grounds-under-review/article19434118/