AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. May 2001, Volume 3, Number 5.

Cases in Law and Ethics

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Terminating a Patient-Physician Relationship

An ethical case about terminating a physician-patient relationship arises when an obstetrician decides to refer a young, pregnant patient who is abusing alcohol early in her pregnancy to a colleague who is not as busy.

Kayhan Parsi, JD, PhD

Ms. Evans, an OB patient at an urban public university hospital, has been abusing alcohol for some time. Dr. Davis, her obstetrician, is concerned about the health of both Ms. Evans and her 18-week-old fetus. He has repeatedly encouraged Ms. Evans to enroll in an alcohol treatment program before she does irreparable harm to her fetus. In response, Ms. Evans has enrolled and tried to follow the program's regimen, but has slipped back to a pattern of heavy drinking. Dr. Davis is getting frustrated with her inability to commit to her treatment program. Moreover, he's concerned about possible complications in the birth and the newborn's health that may arise as consequences of Ms. Evans' alcohol consumption. He feels his practice is already overburdened with high-risk patients and wants to reduce his exposure to potential liability. He decides to refer Ms. Evans to Dr. Green, a younger colleague who is not as busy.

  1. Does Dr. Davis have a professional duty to retain Ms. Evans as a patient under all circumstances? Is her non-compliance an ethically appropriate reason for Dr Davis to attempt to refer Ms. Evans to another physician? Is his anticipation of birth complications in a practice already burdened with many high-risk patients an ethically sound reason for the transferral?
  2. How should Dr. Davis go about terminating his relationship with Ms. Evans?
  3. What should Dr. Davis do if Dr. Green does not wish to accept Ms. Evans as a patient?
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