Part One - The Social Responsibility of Catholic Health Care Services
CASE STUDY
CASE #1: AN UNDESIRABLE PATIENT
Angelina, a 32-year-old woman struggling personally with many issues, has been contemplating whether she should go to the doctor for medical tests. She knows she needs to because she has had "flu-like" symptoms for several months and has been feeling worse as of late. She suspects there is something really wrong, which is one reason why she has been reluctant to take the necessary step because she does not want her worst fears confirmed. The other, more practical, reasons are that she does not have health insurance, does not have enough money to pay for any tests, and is extremely concerned that the physician will look down on her because of her obesity and her alcoholism should she decide to disclose this latter fact. Despite her concerns, Angelina visits a physician in your medical group. During lunch one day in the physician's lounge, the physician who saw Angelina tells you and other colleagues about the visit and notes how he is sick of taking uninsured patients and especially sick of taking care of "fat people who aren't willing to take care of themselves." Most of your colleagues nod in agreement but some seem troubled by his comments. (Courtesy of Dr. Michael Panicola, SSM Health Care, St. Louis, Mo.).
CASE QUESTIONS
1. What ethical issues do you see here?
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- A vulnerable woman without health insurance. Is there an issue of justice here?
- Disrespect — a violation of her dignity
- Bias/discrimination
- Care of the poor and marginalized
- Care for the whole person — body. mind, and spirit
- Breach of privacy/confidentiality
- Stewardship of resources
2. Which Directive(s) apply to the case?
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- Directives 1, 2, 3, 9, 5 and possibly 6; also applicable are the Introductions to Parts Two and Three.
3. How might the Directive(s) help address the case?
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- At minimum, the physician should not be speaking publicly about one of his patients and doing so in such disparaging terms, even though his concern and his frustration are understandable.
- Catholic health care is committed to caring precisely for such patients — those who are vulnerable and at the margins.
- Catholic health care is also committed to caring for the whole person (see Introduction to Part Two). There is more at issue here than the woman's physical health. There are also mental health and addiction issues. A referral to a social worker seems called for in order to connect this woman with resources to address her mental health and addiction issues, and possibly obtain resources to provide for her health care. There may also be underlying spiritual needs and/or issues that could be affecting her physical and mental health that should also be addressed.
- Good stewardship of resources might suggest or require a different approach to caring for this patient.