Can doctors refuse to treat patients based on their political beliefs?

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April 6 2010 4:44 PM

First, Do No Harm to Your Political Party

Can doctors refuse to treat patients based on their political beliefs?

Is a right-wing doctor allowed to unload his left-leaning patients?
Is a right-wing doctor allowed to unload his left-leaning patients?

Incensed by the recent passage of health care reform, Florida physician Jack Cassell taped a sign to his office door advising Obama supporters to "seek urologic care elsewhere." Cassell does not plan to quiz would-be patients on their views, but many bioethicists believe he crossed the line of professional conduct. His actions raise the question: Can doctors refuse to treat patients based on their political ideology?

It depends on the circumstances. Hospitals and ambulances must provide emergency care to everyone regardless of citizenship, ability to pay, or any other criterion. But the government has not yet enacted a universal right to basic or preventive care, which means a private provider can refuse to treat a walk-in patient with a sore throat or a bum knee, say, just because he's wearing an "I Love Obama" pin. The exception here is if the doctor and his liberal patient had a pre-existing relationship. Turning away a current patient—whether by explicit instruction or passive-aggressive signage—constitutes abandonment, a potential violation of both professional ethics and the law. In order to sue successfully for medical negligence, the patient must prove that he was in need of care, that his doctor terminated care without giving proper written notice or helping to find a replacement, and that he suffered an injury as a result of the doctor's breach of duty.

From a civil rights perspective, Cassell is probably in the clear. While the law bars physicians from excluding patients on the basis of traditionally protected classes like race, religion, national origin, and disability, most jurisdictions permit political discrimination. One notable exception is the District of Columbia, which, along with a handful of other cities, specifies that it's not OK to discriminate based on political affiliation.

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Even if the Florida urologist's stunt does not constitute unlawful discrimination or abandonment, he certainly violated the American Medical Association's Code of Medical Ethics. According to Opinion 9.012, "Under no circumstances should physicians allow their differences with patients or their families about political matters to interfere with the delivery of high-quality professional care." But the AMA is merely a club, and its sanctions have no teeth—especially since Cassell isn't even a member. Pointing to the code as a statement of national consensus on professional standards, an aggrieved party could lodge a formal complaint to the state licensing board. A revocation of license would, however, be unlikely for this particular offense. At worst, the board might require the physician to receive several hours of ethics training.

Bonus Explainer: Are urologists more likely than other doctors to lean right? No. According to a 2007 study, conservatives tend toward surgery, anesthesiology, pathology, and radiology, while liberals tend to choose psychiatry, gynecology, and pediatric sub-specialities. Predictably, the authors found a strong correlation between political conservatism and disagreement with the belief that access to health care is a human right.

Explainer thanks Dr. Steven Miles of the University of Minnesota, Dr. Arthur Caplan of the University of Pennsylvania, and Dr. Matthew Wynia of the American Medical Association.

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