Kimani Paul-Emile, Alexander K. Smith, Bernard Lo, and Alicia Fernández
N Engl J Med 2016; 374:708-711
Here is an excerpt:
Beyond these general legal rules, when patients reject physicians on the basis of their race or ethnic background, there is little guidance for hospitals and physicians regarding ways of effectively balancing patients’ interests, medical personnel’s employment rights, and the duty to treat. We believe that sound decision making in this context will turn on five ethical and practical factors: the patient’s medical condition, his or her decision-making capacity, options for responding to the request, reasons for the request, and effect on the physician (see flow chart). It’s helpful for physicians to consider these factors as they engage in negotiation, persuasion, and (in some cases) accommodation within the practical realities of providing effective care for all patients.
The patient’s medical condition and the clinical setting should drive decision making. In an emergency situation with a patient whose condition is unstable, the physician should first treat and stabilize the patient. Reassignment requests based on bigotry may be attributable to delirium, dementia, or psychosis, and patients’ preferences may change if reversible disorders are identified and treated. Patients with significantly impaired cognition are generally not held to be ethically responsible.
The article is here.