(An article inspired by Prof Akinbiyi’s dilemma)
By AG Ahmed, MB, LLM, FRCPC
Forensic Psychiatrist,
Full Professor of Psychiatry USask
Dec 24, 2023
Introduction:
The medical field is grounded in trust, ethical conduct, and the welfare of patients. Doctors are tasked with the duty of delivering impartial and optimal care to their patients. However, the situation becomes ethically complex when doctors are faced with treating their own family members. This article delves into the reasons why doctors are discouraged from treating their own kin, backed by credible sources and a real-life case study.
Case Study – The Experience of Dr. Akinbiyi:
Dr. Akinbiyi, a Nigerian doctor practicing in Canada, encountered a challenging situation when his daughter fell ill. Despite the general ethical guidelines that discourage doctors from treating their own family members, Dr. Akinbiyi was twice compelled to treat his daughter due to the unavailability of other doctors. These incidents led to a complaint with the hospital administration, highlighting the complex ethical issues that can arise when doctors are compelled to treat their own family members, particularly in situations where other healthcare providers are not readily available. This case underscores the importance of healthcare institutions providing adequate support and resources to their staff to ensure that such situations can be avoided.
A) Ethical Considerations:
1. The Issue of Conflict of Interest:
A significant reason why doctors are discouraged from treating their own family members is the inherent conflict of interest. The emotional connection and personal relationship between a doctor and their family member can obscure their judgment and hinder their ability to provide unbiased care. This conflict can result in prejudiced decision-making, potentially jeopardizing the patient’s health.
The American Medical Association (AMA) advises against doctors treating family members due to the potential for compromised objectivity and professionalism. The International Code of Medical Ethics by the World Medical Association also underscores the need to avoid conflicts of interest in patient care.
2. Compromised Professionalism:
Treating family members can blur the lines between personal and professional relationships, which can erode the doctor’s professionalism. The doctor may struggle to uphold the necessary objectivity, confidentiality, and professional distance required for effective medical care.
The American College of Physicians (ACP) asserts that treating family members can lead to compromised professionalism, as it may be challenging for doctors to separate their personal emotions from their professional duties. The ACP’s Ethics Manual further emphasizes the need to maintain professional boundaries to safeguard the patient’s best interests.
3. Loss of Objectivity:
Objectivity is a crucial element of medical practice. Doctors are trained to approach patient care with an unbiased viewpoint, relying on evidence-based medicine and clinical judgment. However, when treating family members, personal biases and emotions can obscure the doctor’s judgment, potentially leading to subpar care.
The British Medical Association (BMA) advises against treating family members, emphasizing the need to maintain objectivity and avoid potential harm to the patient. The BMA’s guidance underscores the necessity for doctors to seek independent opinions and consultations to ensure the highest standard of care.
B) The Stance of the Canadian Medical Association:
The Canadian Medical Association (CMA) shares a similar viewpoint with other medical associations regarding doctors treating their own family members. The CMA’s Code of Ethics states that doctors should not treat themselves or their immediate family members, except in emergency situations or where no other qualified healthcare professional is available. The CMA acknowledges the potential for conflicts of interest, compromised objectivity, and impaired professionalism when doctors provide care to their own family members. The Code of Ethics stresses the importance of maintaining professional boundaries and ensuring that patients receive the highest standard of care.
C) The Case of Treating One’s Own Child:
When a doctor is asked to treat their own child, they should generally abstain from doing so, except in cases of emergency or when no other qualified healthcare professional is available. This is due to the potential for compromised objectivity, professionalism, and conflicts of interest. In emergency situations, a doctor-parent may need to provide immediate care to their child until another healthcare provider can take over. However, once the emergency is over or another healthcare provider is available, the doctor should transition the care of their child to that provider.
D) The Policy of the College of Physicians and Surgeons of Saskatchewan:
The College of Physicians and Surgeons of Saskatchewan (CPSS) has a policy that discourages doctors from treating themselves or their family members, except in emergency situations or when another doctor is not readily available. The policy states that in such situations, the care provided should be limited to minor or short-term problems, and that ongoing care should be transferred to another doctor as soon as possible.
Conclusion:
The prohibition on doctors treating their own family members is rooted in the principles of professionalism, objectivity, and patient welfare. The potential for conflicts of interest, compromised professionalism, and lack of objectivity necessitates the establishment of clear boundaries between personal and professional relationships in healthcare. By adhering to these ethical guidelines, doctors can ensure that their patients receive the best possible care, free from personal biases and emotional influences. The references provided from reputable medical associations and organizations, along with the real-life case study, support the importance of maintaining professional boundaries in the interest of patient well-being.
References:
1. https://fij.ng/article/after-forcing-nigerian-doctor-to-treat-daughter-twice-canadian-hospital-bullies-him-for-complaining/
2. American Medical Association. (2016). Code of Medical Ethics Opinion 8.19 – Self-treatment or Treatment of Immediate Family Members. Retrieved from https://www.ama-assn.org/delivering-care/ethics/self-treatment-or-treatment-immediate-family-members
3. World Medical Association. (2018). International Code of Medical Ethics. Retrieved from https://www.wma.net/policies-post/wma-international-code-of-medical-ethics/
4. American College of Physicians. (2019). Ethics Manual, Seventh Edition. Retrieved from https://www.acponline.org/system/files/documents/about_acp/ethics_manual_7th_edition_full_text.pdf
5. American College of Physicians. (2019). Ethics Manual, Seventh Edition: Chapter 1 – Physician Responsibilities. Retrieved from https://www.acponline.org/system/files/documents/about_acp/ethics_manual_7th_edition_chapter_1.pdf
6. British Medical Association. (2019). Treating oneself or close family members. Retrieved from https://www.bma.org.uk/advice-and-support/ethics/ethics-a-to-z/treating-oneself-or-close-family-members.
7. Canadian Medical Association. (2004). CMA Code of Ethics. Retrieved from https://policybase.cma.ca/documents/policypdf/PD04-06.pdf