The Doctor's Dilemma…and a Doctor's Duty

The more things change, the more things stay the same…The truth of that cliché hit me recently, when I saw George Bernard Shaw’s “The Doctor’s Dilemma.”  The play deals with a doctor who has a revolutionary treatment for tuberculosis.  He can only treat ten patients, however, and he falls for a woman who is begging him to treat her ill husband instead of one of the chosen ten.

sb10063567v-001Replace tuberculousis with ebola, change the costumes, and this play could have taken place in the past month.  One hundred years ago the medical profession was questioning how to treat tuberculosis, which was a devastating and contagious disease then.  Today, doctors are trying to figure out what experimental treatments should be used for victims of the ebola virus.  The doctors in the play were complaining about issues that are still true today – patients who pop too many pills and latch onto medical fads to take care of their problems.

The play poses the question: who is more important to save, the incredibly talented but morally reprehensible person or the very nice and ethical but otherwise average person?  The doctor with the experimental treatment also has to address the ethical question of whether he should bump somebody from the trial for the husband of the woman he loved.

I’m not touching the first question (dammit, I’m a lawyer, not a philosopher) but the second one is a legal one that I can explore.  By replacing one patient in his trial with another, the doctor is terminating the relationship with the first patient.  Can a doctor do that if the patient doesn’t want the relationship to end?

The answer is yes – but it’s not always easy.  And if it’s not done correctly it could form the basis for a claim of “medical abandonment,” which can be part of a medical malpractice claim but is also treated as a separate claim sometimes.  See McGaughey v. D.C., 740 F. Supp. 2d 23, 30-31 (D.D.C. 2010).  Doctors can terminate the doctor-patient relationship but various states have different requirements for such a termination.  In California, a doctor must give the patient due notice and an ample opportunity to secure other medical care.  See Scripps Clinic v. Superior Court, 108 Cal.App.4th (2003).  In South Carolina, a physician can’t end the relationship without reasonable notice to the patient.  See Melton v. Medtronic, Inc., 389 S.C. 641, 652, 698 S.E.2d 886, 892 (Ct. App. 2010).  Other states seem to have similar standards, with at least some making it easier over the years for the doctors to end a relationship with a patient.

TheaterI saw the play at the American Player’s Theater in Spring Green, Wisconsin.  I haven’t been to many outdoor theaters but this venue is absolutely fantastic: the trees provide a magnificent backdrop, the seating gives everyone a close view of the stage, and the bats keep the mosquitos away.  The walk up the hill to the “Up-the-hill stage” is beautiful and romantic.  I couldn’t find it on any list of the top outdoor theaters but it definitely should be!