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Should Doctors Be Allowed to Choose Not to Treat Fat People?

In which the challenges of discrimination are dissected.

by
Theodore Dalrymple

Bio

May 11, 2013 - 7:00 am
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Let us take the question of immunization of children as an example. Some general practitioners have refused to treat families whose children are not immunized according to the recommended schedule. They do so on the grounds that a visit to the doctor’s office by an unimmunized child may pose a threat to children who happen to be visiting at the same time. Yet the empirical risk is probably not known and very likely to be small, if it exists: probably much smaller than that of leaving a child of a crankish family without medical advice. In other words, the refusal is an expression of the physician’s irritation, perhaps even of wounded amour propre, rather than of concern for the welfare of children.

Obesity also raises questions of medico-political philosophy.  Surgeons, for example, sometimes refuse to operate on very fat people, especially for conditions that are not life-threatening, because the results are poorer and the rate of complications higher. This is important not only for the patient, but for the surgeon who might be judged by his results. No doubt physicians who refuse to treat the fat are more likely to see them as weak-willed rather than the victims of genetic endowment, physiology or even of society; but some doctors refuse to treat the fat on the grounds that they do not have the special equipment needed to do so. The authors of the article suggest that this is wrong; that the correct approach is that they, the doctors, ought to buy the necessary equipment. The authors, though, do not tackle the question of who is to pay for it: the doctors, the fat themselves, or the other patients? The answer given will depend crucially on one’s moral attitude to obesity.

In practice, say the authors, not many patients face discrimination; doctors still try to do their best for people as they find them. But they conclude:

Overt discrimination is rare. Evidence suggests, however, that even medical professionals are susceptible to implicit based on race, social class, sex, weight, and myriad other factors that may affect the care they provide.

This sounds ominously like an Inquisition’s charter to me. Perhaps there can be no freedom without tolerance of discrimination.

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Theodore Dalrymple, a physician, is a contributing editor of City Journal and the Dietrich Weismann Fellow at the Manhattan Institute. His new book is Second Opinion: A Doctor's Notes from the Inner City.

Comments are closed.

Top Rated Comments   
As a fat person, I affirm the right of a physician (and all individuals) to free association. No one is morally entitled to trade. We should each be able to do business with whom we wish, for whatever reason we wish. Legal mandates to the contrary are immoral and ought to be abolished.
49 weeks ago
49 weeks ago Link To Comment
All Comments   (64)
All Comments   (64)
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What I don't understand is why when I go in to see a Doctor with cash in hand, I can NOT be offered a better deal than patients whose insurance company, medicaid, or medicare will take many months and valuable man hours of the billing offices time before sending a reduced payment. I have been told it would violate agreements with the insurance companies.
48 weeks ago
48 weeks ago Link To Comment
Its a free market. Doctors should be able to treat whomever they want, or don't want. Overweight, old, gay, straight, liberal or conservative, babies, Christian, Jewish, Muslim, black, white, whatever. Doctors should treat who they want. Dying in the ER? Pass the test and we'll treat you, if not, too bad so sad. Its all about LIBERTY or something. More libertarian claptrap.
48 weeks ago
48 weeks ago Link To Comment
we're angry. we're turning our hate on each other. we have no control over our lives any longer, we are not allowed to love our country and value american exceptionalism, our leaders are flaccid in all regards and all matters of urgency to the middle class. we are swamped with those not only of different cultures, but those who are wedded to the cultures that despise America. and worse to come.
48 weeks ago
48 weeks ago Link To Comment
If a physician doesn't want to provide preventive healthcare and treat 'human beings' illnesses and disease as they present, then they should choose another occupation. Physicians are the nations societal healthcare public servants, independent of politics, religion, race, sexual orientation, etc. There is something sorely wrong as a human being, any physician who discriminates against human chararteristics in their healthcare practices. That said, just like our society at large, many physicians too, are losing the moral compass and professional purpose.
48 weeks ago
48 weeks ago Link To Comment
That's nice you climbed on your morally superior high horse. We applaud you for caring about others. However, government mandates of private behavior is thuggery; taxing over it is legalized robbery. There is something sorely wrong as a human being, when a private person like yourself believes he has the right to mandate what other private individuals should do with their private businesses. Or are you telling the truth, in that Obamacare will make doctors public entities under the direction of the government?
48 weeks ago
48 weeks ago Link To Comment
Or private individuals uniting as gangs or clubs with exclusive membership controls and identity codes . Who have decided and been obeyed within this past half century who, what, why, when and how anyone in the socierty iis to be permitted to do, say, opine, act upon anyone considered outside their benevolent care. That gang which calls itself compassionate, liberal and believe it or not democrat. Successfully with insinuation of their members into policy echelons in all civic institutions of the nation within this half century to "do their damndest" with collaboration of that other special club of the best and brightest" with aims to deconstruct the world in which their targets live.
48 weeks ago
48 weeks ago Link To Comment
I'm representing the american generations and classes that made america the exceptional world leader it once was -- something you have no experience or knowledge of. You're a part of the generations who have helped destroy American exceptionalism replacing it with a dog-eat-dog individualist society who don't give a flip about anybody or anything but yourselves. It is you and your generations that are the cause of more and more social legislation because, you're socially irresponsible all while claiming human superiority in your Christianity roots -- one defies the other!
48 weeks ago
48 weeks ago Link To Comment
No one cares who you supposedly "represent". Poser.

If you want to make doctors your slaves, then say so.

How much do you weigh?
48 weeks ago
48 weeks ago Link To Comment
Well, aren't you a real piece of work! You're barking at the wrong person if you think I'm soem sickly fat person living in a doctors office or the hospital. I weigh the very same I did when I went into the Marine Corps in 1954 which is the same as when I retired in 1986. I have zero health problems other than a tired back from good old time hard larbor. I eat like a starved horse and anything that I want to eat. Everybody on my family tree from both sides of the family, native american indian and german, norwegian live into the upper 90s. Anymore stupid questions!
48 weeks ago
48 weeks ago Link To Comment
A doctor *shouldn't* want to refuse to treat someone if he or she is true to their oaths and calling, but that doesn't mean that a doctor always can or will or should be compelled through force of law to treat someone. Doctors are not slaves and their services are not a right.
48 weeks ago
48 weeks ago Link To Comment
Already happening to smokers at the VA, at least at Madison VA. They will not provide any bone grafts- i.e., for disunion of broken bone. Their science is weak, and they will not share it, but they won't do the operation either.
48 weeks ago
48 weeks ago Link To Comment
Do we really want the government to tell doctors who the hell they can treat? After all, a doctor's time is finite; there will always be doctors to treat fat people. If you are obese and he doesn't want to, change doctors. Thomas Sowell said it best when he commented that Americans are the only people who believe that laws should be passed to please every private whim. Get a life and take charge of your own problems.
48 weeks ago
48 weeks ago Link To Comment
You can always tell the city folks by their arrogant uniformed commenting. Are you willing to drive 75 miles to change doctors when you live in a rural community served by only one doctor? Most of this nations land mass is rural and often already only served by one or maybe two visiting (traveling) doctors and nurses. The sun doesn't rise and set in only the larger cancer cities of the nation!
48 weeks ago
48 weeks ago Link To Comment
So move. No one promised you a rose garden. You live in the sticks, you will probably die there.
48 weeks ago
48 weeks ago Link To Comment
You don't stand for anything, do you? You just want to argue for the sake of hearing yourself sound clever. Now you pretend to sound like a flyover.
48 weeks ago
48 weeks ago Link To Comment
Look Howie, I was born in the early 30s in NW Oklahoma and raised there. Members of my large family and relatives still live there, We operate corporate land and cattle companies in five planes states. Take your arrogant ignorance somewhere else!
48 weeks ago
48 weeks ago Link To Comment
Back in 1986, during my mother's final months, I had taken her to her surgeon's office for examination and a dressing change. They had parked me in an empty examination room while this was going on. The surgeon came onto the room, quite upset. We had been on good terms, so I said that he could talk to me as a friend. He said that he had just turned down a patient for a liver transplant because he was sure that the man would die on the table becase he was so obese. The patient was an alcoholic who had destroyed his own liver. We talked for a while and he went on to see his next patient. I came away from this with a greater respect for this surgeon. He didn't just coldly turn the man down, he was punching-out-the-drywall upset that he couldn't save him.
48 weeks ago
48 weeks ago Link To Comment
One thing I could never understand about the immunization issue is if all the other children have had their shots, why would one child who hasn't be a danger to them? There was a Law and Order episode about this very thing, and it didn't make any sense math-wise. It seems to me the only child in danger is the one without the shot.
48 weeks ago
48 weeks ago Link To Comment
ok, it is off topic, but a serious question so i'll do my best in short space. the un -immunized child is not a danger to those with immunization. he is a danger to other un-immunized children. when the populace in general has been immunized the herd immunity protects the relative few who aren't as there is a point at which the minimum number of contacts to cause epidemic is not reached. as the number who chose to go without increases, at some point contagious spread again becomes possible and all un-immunized are at risk in an epidemic. immunization for something like rabies or tetanus is for the good of the individual. in contagious disease like polio, measles, diphtheria it is for the communal good. i hope this helps
48 weeks ago
48 weeks ago Link To Comment
I was fired as a patient by my gynecologist when I had a panic attack in her office. I was there to find out the results of a biopsy, to find out if I had cancer and, I might add, was also going through an extremely stressful situation with a family member. So I had a panic attack and she told me to leave, she would no longer have me as a patient.

I respect her right to decide who she will and will not treat. And I would rather not have a doctor so thoroughly lacking in understanding.

A doctor's practice is a business. Doctors should run their business as they think best. More importantly, we must maintain a system where patients have alternatives when a particular doctor refuses to give them care. I am not so much bothered by the thought that a particular doctor chose not to me my doctor, as by the realization that we are building a system where patients will have fewer choices in such a situation.
48 weeks ago
48 weeks ago Link To Comment
a doctor can fire a patient, but in an ongoing relationship it is more complicated than saying go away. that risks an abandonment law suit. something is missing from this story. to not take on a new patient is one thing, to not continue a patient after one event is finished and there is no desire to work into the next is another. to terminate while in a therapeutic situation is something else again. awaiting the results of a biopsy is pretty much the definition of abandonment UNLESS the results were negative and you were told that due to your disruptive nature she did wish to continue as your physician. which i suspect is close to what happened.
48 weeks ago
48 weeks ago Link To Comment
My disruptive nature was that in a state of mental confusion I asked the doctor's assistant to let my husband come back to sit with me. He was in the waiting room. She started to leave the examination room so I called in what I admit to have been a loud voice to tell her his name, so that she could bring him to me. The doctor came in at that moment and said I was yelling and said I could no longer be her patient.

I did describe the situation to a lawyer friend of the family, just to get his opinion. I do not know if rules vary depending upon state, but the lawyer said that a doctor could fire a patient for any cause.
48 weeks ago
48 weeks ago Link To Comment
I can't imagine, a male doctor doing that. Ever. But a female doctor? Oh yeah. How dare you, be such a nuisance in her office! An unquiet patient, can't have that!
48 weeks ago
48 weeks ago Link To Comment
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