Reflections from the Front: Treating Family Members
In my last few blogs I have been addressing different aspects of the broad concept of conflicts of interest. To continue, though really in a different vein, when is it appropriate for a medical provider to medically care for a close friend or family member? This is a somewhat controversial, old but new question that has recently shown up again on our ethical radar. http://www.ama-assn.org/amednews/2009/04/13/prca0413.htm
A few situations seem obviously concerning: Life endangering but necessary surgery on a loved one, procedures with permanent ramifications performed on a minor child, or overseeing experimental drug trials on a loved one come to mind.
Other scenarios seem more appropriate: emergently performing life-saving surgery when no other qualified surgeon is available, helping to oversee medical regimens in tandem with an unrelated physician who closely monitors progress, providing supportive non-surgical, non-pharmacologic treatment to dying family members, or refilling medications originally ordered by a treating physician who is temporarily unavailable.
What about cases in the middle? If you are the most qualified, skilled plastic surgeon available is it appropriate to perform elective cosmetic procedures on family and friends? Why or why not? This is not an easy question, and many plastic surgeons currently perform surgeries on their family members. http://www.ncbi.nlm.nih.gov/pubmed/20195128
1) Objectivity in treating patients is critical, and may be difficult if not impossible to achieve with loved ones.
2) Unless you are facing an emergency, your children and your spouse need you more as a parent or spouse than as a doctor. There are other doctors who can help, but only one you.
3) Consent may be complicated, raising questions of coercion, again.
4) Failed therapeutic endeavors may permanently alter core family relationships.
5) If despite providing the best possible care for your relative, mistakes happen (and bad things happen even without mistakes) not only may it alter core relationships, but it may prevent appropriate remuneration for injured parties.
6) Compliance on the part of family members may be even more complicated than usual compliance issues.
7) While in general it might seem fairly innocuous to volunteer your services for family members’ care, it is seldom as uncomplicated as it seems.