Do Not Resusitate
We must recognize that there are legitimate reasons across all fields of health care to cease providing treatment to a patient. Some of these are clear-cut. First, when treatment needs exceed the ability and expertise of a health care professional, the patient is best served by having care transferred to a more qualified practitioner. Since the goal of health care is the well being of the patient, withdrawing from a case when one's skill can no longer be of benefit is justified, even though claims of abandonment may be raised by the patient. However, the manner in which one presents the need for a transfer of care, and the degree to which the patient is made aware of this need and involved in the choice of a new practitioner, are important factors in lessening the patient's perception of abandonment.
Second, it is commonly agreed that a health care practitioner may withdraw from the care of a patient who acts inappropriately within the health care setting. The most common situation discussed is when a patient becomes violent or acts in ways that endanger the practitioner, other patients, or staff. However, this would also include inappropriate sexual advances from a patient (or possibly from a patient's guardian, spouse, parent, etc.). In such cases, a practitioner may, if necessary, withdraw from the treatment of the patient without abandoning the patient, as the health care relationship has already been severed and the bond of trust damaged.
A third area, but one, which involves more difficulty, arises from issues regarding the cultural and religious values of health care practitioners. As noted in the Comprehensive Accreditation Manual for Hospitals â€“ Refreshed Core (JCAHO, Jan., 1998, p. HR-21), in the delivery of health care there should be respect for a health care practitioner's, "â€¦ cultural values, ethics, and religious beliefs and the impact these may have on patient care". The Manual