Module 1: Professional Accountability and Prescribing

What is at issue?

In the case of SM, the issue is that provider bias in working with an alcohol-dependent patient prevented investigation and treatment, resulting in the patient’s death. SM suffered with cancer pain for a long time, and in addition his alcohol dependency went untreated. Providers did not respect SM’s autonomy as full options for treatment were not offered. Moreover, both beneficence and nonmaleficence were compromised as the omission of treatment options caused SM significant harm. As to the principle of justice and fairness, available resources were not offered.

Where is the conflict?

Since SM died, the conflict is between the providers and the standards of care delivery expected by the institution and society. Community members expect care providers to be competent, to treat all individuals fairly, and to improve the quality of life for all. Given that SM had a dependency issue, should treatment have been withheld based on the assumption that he would be unlikely to overcome his addiction and become a fully contributing member of society?

What is this a case of?

Does SM’s situation sound like any other situations you have encountered? This is a case of social stigma causing harm. While society encourages alcohol use in many social situations, social stigma is a barrier to the appropriate treatment of alcohol dependency.

What do we know about other cases like this one?

How is it different? Is it similar (or different) in ethically significant ways?

Stigma and bias is common when mental health issues are present. The principles of respect for autonomy, beneficence, nonmaleficence, and justice can be quickly compromised. Training and education of health care providers is critical to increase awareness of the impact of stigma on patient care.