Refusing to treat a patient because of their sexual orientation or on gender identity is unethical and, in some states, illegal. In the state of Michigan, where the pediatrician refused to treat the child of a lesbian couple, the law does not apply but the ethics do. The pediatrician who refused treatment, based upon the pediatricians “religious” beliefs shows that even a religious belief can be unethical, and in my opinion, immoral.
The complex ethics of this question go to the four pillars of modern ethics of medicine. In this case, autonomy – physicians are allowed to have autonomy in dealing with patients, but our choice is best outlined by the American Medical Association, which states that , “Physicians who offer their services to the public may not decline to accept patients because of race, color, religion, national origin, sexual orientation, gender identity or any other basis what would constitute invidious discrimination.”
In the case of the pediatrician, while they were not being illegal, they were being unethical. This does not mean, however, that the Michigan medical board cannot act. In fact in the Michigan health code it states, ” A patient or resident shall not be denied appropriate care on the basis of race, religion, color, national origin, sex, age, disability, marital status, sexual preference, or source of payment.” – so while Michigan is not listed regarding discrimination, that pediatrician may still be censured by the Michigan medical board.
Physicians can choose to not treat patients based on the type of treatment (abortion being the classic example) or based on a situation (if the surgeon feels that their operation may cause more injury than help) or based on the patient and the physician having an adverse relationship (often this can come down to a patient refusing to pay for a physician’s services, or a patient who is known to be litigious), or in certain situations (refusing to treat patients who are in automobile accidents for injuries that are likely to end up in court). Some physicians refuse to treat malpractice attorneys (although this seems like a class warfare).
We physicians must be above discrimination. Being a physician is a privilege, and we must be on the side of public good. One of the four tenants of medical ethics is justice, and physicians must be active in providing care and not discrimination.
States Prohibiting Discrimination Based on Sexual Orientation
|District of Columbia||Nevada||Vermont|
States Prohibiting Discrimination Based on Gender Identity
|District of Columbia||Minnesota||Vermont|
Dr. Terry Simpson
Dr. Terry Simpson received his undergraduate and graduate degrees from the University of Chicago where he spent several years in the Kovler Viral Oncology laboratories doing genetic engineering. He found he liked people more than petri dishes, and went to medical school. Dr. Simpson, a weight loss surgeon is an advocate of culinary medicine. The first surgeon to become certified in Culinary Medicine, he believes teaching people to improve their health through their food and in their kitchen. On the other side of the world, he has been a leading advocate of changing health care to make it more "relationship based," and his efforts awarded his team the Malcolm Baldrige award for healthcare in 2011 for the NUKA system of care in Alaska and in 2013 Dr Simpson won the National Indian Health Board Area Impact Award. A frequent contributor to media outlets discussing health related topics and advances in medicine, he is also a proud dad, husband, author, cook, and surgeon “in that order.” For media inquiries, please visit www.terrysimpson.com.