Markkula Center of Applied Ethics

The Duty of the Physician to an Uninsured Patient

Response to the Case of Madisyn Whitfield
By Ella Sanman

The case of Madisyn Whitfield presents many different ethical issues, but I am going to focus on the ethical obligation of her Crohn's disease specialist to provide Maddy with care when he or she knows that Maddy no longer has health insurance.

The specialist is aware of her worsening condition and of the factors that are outside her control. Physicians are obligated to act in a beneficent manner-that is to do what is in the best interest of the patient. By ignoring her follow-up care, the physician is not demonstrating beneficence. The specialist has the responsibility to either give her the care through his or her practice or refer her to another physician who could help her, even though she does not have insurance. It is unacceptable for a physician to leave such a sick individual without proper care.

According to the American Medical Association's Principles of Medical Ethics, "A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care." The problem with this statement is that the definition of an emergency is situational. For some, Maddy's case could be viewed as an emergency, based on the urgency and worsening health conditions she is facing. For others, based only on initial observation, it could be viewed as non-emergent.

That's why so many patients like Maddy end up in the Emergency Room, where care cannot be denied. But, as this case shows, ERs are not the optimal setting for dealing with chronic conditions. Ultimately our health care system needs systemic reform so that physicians, like Maddy's Crohn's specialist, can deliver quality care to patients who lack financial resources.

Ella Sanman was a 2008-09 Health Care Ethics Intern at the Markkula Center for Applied Ethics.

July 2009


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