Re: Should Clinicians Challenge Faith-Based Institutional Values Conflicting with Their Own?
AMA J Ethics. 2018;20(7):E630-636. doi: 10.1001/amajethics.2018.630.
Sierra Teegarden
York College Physician Assistant Program
Biomedical Ethics
June 3, 2021
Case Summary
A sexually active 19-year-old female patient is seeking contraceptive management from her primary care physician at a Catholic health care organization. Her physician agrees she is a good candidate for oral contraceptive pills (OCPs) but is unable to prescribe it for contraceptive management because it is against the organization’s policy for religious objections. Since providing contraception is a legal medical service, the provider agrees to the patient’s suggestion of prescribing the OCP as an acne treatment despite that not being the intended use.
Ethical dilemma
Should a healthcare provider exercise the autonomy of the patient if it medically acceptable but goes against the policy of the institution they are employed by for non-medical observances? Clinicians have an ethical duty to provide appropriate medical care that is in the best interest of the patient. Prescribing oral contraception to prevent an unwanted pregnancy in this case scenario is the best treatment choice to respect the patient’s autonomous decision.
Moral Argument
The four core concepts that guide a Physician Assistant’s ethical duty are autonomy, beneficence, nonmalifacence, and justice. The AAPA states that “patients have the right to make autonomous decisions and choices, and PAs should respect these decisions and choices.” A patient has the right to choose oral contraception as a medical option for themselves given that there are no overt medical contraindications to the prescription choice. This case study demonstrated a provider who was in medical agreement with the patient, demonstrating beneficence because it is within the patient’s best interest to have reproductive protection. When considering nonmaleficence, harm would have been done by denying the patient viable contraceptive options on the basis of religious observances because it directly puts the patient at risk for an unwanted pregnancy and the medical risks that are associated with it. Additionally, there are socioeconomic risks the patient would be subject to if she became pregnant at a suboptimal time in her life. The provider practiced justice because any patient with similar circumstances would receive similar care outside of a religious health institution. By denying reproductive resources, the patient would have been denied justice.
Objections / Alternate Interpretations
An alternate interpretation of nonmaleficence could be that by prescribing a treatment under a diagnosis that it is not primarily intended for could impose unnecessary or unacceptable psychological or legal burden on the patient by the act of deception. However, it could be argued that the consequences of not having adequate contraception could impose greater harm to the patient and does not take into account the patient’s autonomy. While not legal, the diagnosis of acne vulgaris is mild enough to not cause future undue harm by being placed in the patient’s medical history. It can also be argued that the patient could be referred to an organization that allows this medical service. However, this goes against beneficence because there may be an unnecessary new patient wait time, transfer of care, and possible insurance conflicts which goes against the patient’s best interest. It may also interfere with confidentiality as a 19-year-old is likely to be on their parents’ insurance plan which could prompt questioning as to why she was referred to a different facility.
Conclusion
While there are alternative actions that could be considered in this scenario, they do not surmount the strong moral reasonings to abide by the patient’s autonomous request given that it is for a legal medical service with no obvious medical contraindications. For this case study, each of the four guiding principles of practicing as a Physician Assistant ethically align with the patient’s request.
Work Cited
AAPA. (2000). Guidelines of Ethical Conduct for the PA Profession. Alexandria, Virginia.
AMA J Ethics. 2018;20(7):E630-636. doi: 10.1001/amajethics.2018.630.
US Conference of Catholic Bishops. Ethical and Religious Directives for Catholic Health Care Services. 5th ed. http://www.usccb.org/issues-and-action/human-life-and-dignity/health-care/upload/Ethical-Religious-Directives-Catholic-Health-Care-Services-fifth-edition-2009.pdf. Published 2009. Accessed May 26, 2018.
