Patient Autonomy vs. Workplace Discrimination: Legal and Ethical Implications

1. Chaney vs. Plainfield HC Center7th Circuit Court of Appeals Erin A. Egan, MD, JD Neiswanger Institute for Bioethics and Health Policy Loyola University Chicago

2. Facts • An African American nurses aide (CNA) was prohibited from taking care of a patient who only wanted white providers • The setting was a long term care facility • There were other issues of racial discrimination • The CAN was given a list of patients to care for each night, but there was always a notation that this resident “preferred” only white providers

3. Issue • Does a patient’s right to choose a provider, or refuse to be treated by a provider, outweigh an employees’ right to be free of the effects of racial discrimination • The allegation by the CNA was that the deference to a patient’s racial biases created a hostile work environment • The facility argued that they had an obligation to honor a patient’s right to choose their own provider, and refusing to honor this choice would result in providing unconsented care

4. Legal Mumbo Jumbo • The trial court dismissed the claim, saying that if the long term care facility had allowed a racially hostile work environment to develop, they were obligated to do so under state laws enforcing patient autonomy. • The 7th Circuit said that there were facts sufficient to make a dismissal of the claim an error • The result is that the case warrants a trial • The court does say that this type of discrimination may create a hostile work environment, and if this is the case legal patient rights protections are outweighed by federal law preventing racial discrimination

5. The Rise of Autonmegaly • Basic Ethical Principles of Healthcare: • Autonomy, beneficence, non-maleficence and justice • Autonomy is given great deference • Justice issues rarely, if ever, outweigh the right of an individual patient

6. American Cancer Society • Choice of providers and plans • You have the right to choose health care providers who can give you high-quality health care when you need it.

7. American College of Surgeons • Today, many of us can choose the physician who will provide our medical care, including, importantly, the surgeon who will perform any operation we may need. • The American College of Surgeons believes that maintaining patient choice is crucial to maintaining high standards of care.

8. World Medical Association • Right to freedom of choice The patient has the right to choose freely and change his/her physician and hospital or health service institution, regardless of whether they are based in the private or public sector. • The patient has the right to ask for the opinion of another physician at any stage.

9. Ethical Result? • What happens to autonomy practically? Do we have to start recognizing other factors as equal to or more important than autonomy? • The recapitulates other ethical dilemmas- when are the patient’s desires, even if irrational, allowed to dictate care. Put another way, do a patients desires always dictate all aspects of care? • Does this decision impact areas other than discrimination?