Duty to Treat?

After reading this article and discussing many points in small groups about it, I still think it is difficult to create a definition with specific instances that health care providers are required to treat and when it is okay for them to back away from a situation. I know that when I decided that I wanted to be a physician, I did think about the risks that I will expose myself to. I remember talking to a recently graduated physician who was thinking about the new responsibility he had. He was wondering what would happen if he was in an airplane and somebody asked if a physician was on board how he would be able to respond. With just four years of training and not much independent care for patients, would he be able to do good, or would he fail and then be liable for any damage he did. It is a valid question, but I can’t help but think that there is an obligation to treat, even with the risk of making a mistake. With four years of intense learning and training, we as physicians will have a much greater ability to treat a person than somebody who is not a physician. In the times of emergencies, I think that it is a moral duty (not a moral option) for us as physicians to respond to the situation.

I thought it was very interesting to discuss the way that physicians and health care providers can be pushed out of their comfort zone or realm of expertise in an emergency. Part of the oath that we took at our white coat ceremony says that we with “Accept responsibility only for those matters for which I am competent”. In a normal, non-emergent situation, I think this rule always applies. In an emergency, this may have to change a bit. If we fail to act as physicians, we are not using the skills and knowledge that we have worked so hard to gain. Although it is a challenge to step up and care for patients in extreme situations and put our own lives in danger, we signed up for this challenge. The article points out that we “freely chose to become health professionals”. We didn’t sign up for just the good stuff, and I pretty sure that none of us thought it would be easy. We knew the expectations and it is our duty to fulfill them.

There has to be some limit to care in most situations, but for each one, the point at which the duty changes is probably different. I don’t think it is possible to come up with and discuss every type of emergency and exception to duty to treat. However, I think that the article did point out some very good points. One of them is in the AMA code of ethics. It says that a physician should not put themselves in a position that would risk their ability to care for more patients. It seems that in a crisis, the suggestion is to take on a utilitarian point of view; doing the greatest amount of good for the greatest number of people. I think that as a physician, we are responsible to decide when this comes into play. We must know our limits and when they are exceeded when treating will inhibit our ability to continue treating other future patients, we may have to rethink our desire to continue acting.

This topic is very difficult to tackle because I would like to think that in an emergency situation I will act appropriately and that I will make the sacrifices necessary to fulfill my obligations as a physician, but I don’t know how I will really react. We can through out hundreds of hypothetical situations and answer them, but I think that the responses may be different because the emotions that go into such decisions do not come into play in the hypothetical realm. In order to know how people will really react in times of crisis, we need to actually be in times of crisis and observe how people respond. I hope that if I am faced with a precarious situation, I will respond by fulfilling my professional duty and taking care of patients to the best of my ability. I want to make the right decisions, and I hope that my emotions would not prevent me from making the best decisions.