CASE 1: STANDARDS OF ETHICS AND MORAL COMMITMENT
A physician received a letter from a hospital informing that his clinical privileges at the hospital had been summarily suspended. The medical executive committee reviewed the suspension and recommended that it be upheld. The hospital board ultimately revoked the physician’s staff privileges. The physician received a hearing before a fair hearing panel, which recommended that he be reinstated. The board, however, upheld the revocation.
The physician alleged, among other things, wrongful termination and intentional infliction of emotional distress. The defendants argued that the courts do not have jurisdiction to review staffing decisions made by private, nonprofit hospitals.
The Court of Civil Appeals of Oklahoma, Division II, found that judicial tribunals are not equipped to review the action of hospital boards in selecting or refusing to appoint physicians to their medical staffs. The authorities of hospitals endeavor to serve in the best possible manner the sick and the afflicted. Not all professionals have identical ability, competence, experience, character, and standards of ethics. The mere fact that a physician is licensed to practice a profession does not justify any inference beyond the conclusion that a physician has met the minimum requirements for that purpose.
Without regard to the absence of any legal liability, the hospital in granting a physician privileges to practice in its facilities extends a moral or official approval to him in the eyes of the public. Not all professional have a personality that enables them to work in harmony with others, and to inspire confidence in their peers and in patients. Courts should not substitute their evaluation in such matters. It is the board, not the court, which is charged with the responsibility of providing a competent staff of physicians. The board has chosen to rely on the advice of its medical staff, and the court cannot surrogate for the medical staff in executing this responsibility. Human lives are at stake, and the board must be given discretion in its selection so that it can have confidence in the competence and moral commitment of its staff.
Ethical and Legal Issues Questions:
1. Do you agree with the court’s decision? Explain.
2. Discuss under what circumstances you believe a court should become involved in an organization’s disciplinary processes (e.g., age discrimination).
CASE 2: MOTHER REFUSES TREATMENT, SPOUSE AGREES
Vega, a Jehovah’s Witness, executed a release requesting that no blood be administered to her during her hospitalization. Vega’s husband also signed the release. She delivered a health baby. After the delivery, Vega bled heavily. Her obstetrician, Dr. Sood, recommended a dilation and curettage (D&C) to stop the bleeding. Although Vega had agreed to permit Sood to perform the D&C, she refused to allow a blood transfusion. Before undergoing the procedure, she signed a second release refusing any transfusions and releasing the hospital from liability. Despite the D&C, Vega continued to hemorrhage.
Because Sood and the other physicians involved in Vega’s case care believed that it was essential that she receive blood in order to survive, the hospital requested that the court issue an injunction that would permit the hospital to administer blood transfusions. The trial court convened an emergency hearing at the hospital and appointed Vega’s husband as her guardian. At the hearing testimony, Vega’s husband testified that, on the basis of his religious beliefs as a Jehovah’s Witness, he continued to support his wife’s decision to refuse transfusions and believed that she would take the same position if she were able to participate in the hearing.
The court, relying in the state’s interests in preserving life and protecting innocent third parties, granted the hospital’s request for an injunction permitting it to administer blood transfusions. Vega was given blood transfusions. She recovered and was discharged from the hospital.
Vega sued, arguing that if her refusal of blood transfusions interfered with certain state’s interests, it should be the state itself, not a private hospital, that asserts the state’s interests. The hospital responded that because it was charged with Vega’s care it had a direct stake in the outcome of the controversy and was a proper party to bring the action.
The hospital had a legitimate interest in receiving official guidance in resolving the “ethical dilemma” it faced: whether to practice medicine by trying to save a patient’s life despite the patient’s refusal to consent to treatment or to practice medicine in accordance with the patient’s wishes and likely watch the patient die, knowing nonetheless that it had the power to save her life. The hospital had conflicting interests and was in the role not of opposing its patient but of a party seeking the court’s guidance in determining its obligations under the circumstances.
Vega claimed that the state’s interest in the welfare of her child is not sufficiently compelling as to outweigh her interest in refusing blood transfusions. Vega maintained that the trial court’s injunction, issued at the behest of the hospital, violated her common-law right of self-determination, her federal constitutional right to bodily self-determination, her federal constitutional right to free exercise of religion, an her state constitutional right of religious liberty. The court concluded that, under the circumstances of this case, the issuance of the injunction, followed by the administration of blood transfusions, violated Vega’s common-law right of bodily self-determination.
Although the hospital’s interests are sufficient to confer standing on it in this case, they are not sufficient to take priority over Vega’s common-law right to bodily integrity, even when the assertion of that right threatens her own life. The hospital had no common-law right or obligation to thrust unwanted medical care on a patient who, having been sufficiently informed of the consequences, competently and clearly declined that care. The hospital’s interests were sufficiently protected by Vega’s informed choice, and neither it nor the trial court was entitled to override that choice. Vega’s common-law right of bodily self-determination was entitled to respect and protection.
Ethical and Legal Issues Questions:
1. What would you do when a patient refuses a blood transfusion and the spouse agrees with her decision, knowing that a blood transfusion may be necessary to save her life?
2. Should a hospital challenge a patient’s refusal of lifesaving blood transfusions?
3. Does the administration of a blood transfusion violate a patient’s common-law right of bodily self-determination?