The Unfeasibility of Zero Tolerance: How Physicians Deal with Discriminatory Patients

For decades, doctors have been banned from “[. . .] refusing to treat people based on race, gender and other criteria” (Associated Press)  However, the reverse scenario—patients refusing treatment from doctors based on prejudices (particularly racism)—has not been fully addressed.  Most medical professionals agree that when a patient refuses treatment from a physician based on race or ethnicity, that request should not be acquiesced.  Indeed, numerous healthcare organizations have independently mandated noncompliance with prejudicial patient demands.  But there is currently no law that enforces this nondiscrimination.  The American Medical Association has declared its plans to establish “Guidelines for Handling Derogatory Conduct in the Patient-Physician Relationship.”  This protocol would apply to “non-life threatening emergencies.”  But many medical cases, while not emergencies, present complicated circumstances in which there is no simple answer.  As a result, in practice, patients’ racist requests are often accommodated.

            At times, there may arguably be a justifiable reason for submitting to a patient’s demands even if they are based on racial preferences.  Recently, an African American nurse in Flint, Michigan accused the medical center where she works of agreeing to a white man’s command that no black hospital personnel handle his newborn who was in the intensive care unit.  Subsequently, no black nurses were assigned to the patient and a note reading “No African-American nurse to take care of baby” was included with the patient’s chart.  Why was the racist father’s command obeyed?  It likely had something to do with the fact that the father had flaunted his swastika tattoo to an attending nurse.  Thus the nurse who consented to the man’s demand may have felt threatened and was reluctant to protest because the man’s child could face the consequences. 

            In other cases, a patient is mentally handicapped or has undergone a traumatic experience and will feel severe anxiety or irritation when approached by a specific physician.  It is not uncommon that a rape victim will react with fear or apprehension upon encountering a physician or other well-intentioned hospital worker who happens to resemble the perpetrator of the assault.  Under these circumstances, it seems that even discriminatory demands should be accepted so as to avoid further mental or emotional distress.   

But even if a racist patient reluctantly accepts treatment from a previously harassed physician, that doctor still must cope with racist remarks and behaviors.  Most physicians believe that such inappropriate conduct, even if relatively minor, should not go unaddressed.  Instead, “Doctors should try to correct the patient who is making ignorant comments by using personality and, to some extent, their position of authority” (Miller).  By firmly yet respectfully disagreeing, a physician may retain composure while not succumbing to passivity.  However, in reality, few prejudices are going to be easily overturned.  Many patients who make discriminatory remarks are elderly.  Because they grew up surrounded by racism and have upheld their beliefs for decades, their prejudices are essentially irreversible.  Some have proposed temporarily withholding treatment to patients who continue to display racism.  This measure seems extreme since a physician’s foremost aim should be to help those individuals in need, despite their skewed beliefs.

Ultimately, a zero tolerance policy regarding prejudiced patients cannot be implemented in a hospital setting.  Studies have shown that patients who do not trust their physicians are unlikely to make full recoveries.  Thus if a patient continues to refuse treatment from a physician because he or she is black, Muslim or of some other discriminated-against group, hospital staff will eventually be forced to relent.  Though patients have the right to refuse medical treatment, hospitals have an obligation to care for patients, even unpleasant ones.     

http://www.bioethicsinternational.org/blog/2008/02/25/how-to-handle-a-prejudiced-patient-ama/

http://www.amednews.com/article/20130304/profession/130309980/7/utm_source=rss&utm_medium=&utm_campaign=20130325

http://www.chron.com/life/healthzone/article/Some-hospitals-grant-patients-racist-requests4302145.php

https://ssl3.amaassn.org/apps/ecomm/PolicyFinderForm.plsite=www.amaassn.org&uri=/ama1/pub/upload/mm/PolicyFinder/policyfiles/DIR/D-373.998.HTM