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Nonabandonment: Medical Ethics
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
TO THE EDITOR:
Quill and Cassel [1] stress that nonabandonment is one of physicians' central obligations that reflects a longitudinal commitment to the patient. In some situations, unfortunately, abandonment is beyond the control of the physician or the patient.
Abandonment is sometimes brought about by an institution. Take, for example, a patient who loses his job and no longer has health insurance or no longer belongs to a prepaid medical group through his employer and therefore no longer has access to a particular practitioner or facility. Even if the physician chooses to see this patient without remuneration, the health facility with which he or she is affiliated will often not show the same generosity. These ruptures can occur with little warning and little opportunity to prepare the patient.
I work in a Canadian military facility that until 1 January 1995 also cared for retired veterans and members of the military. With only 6 weeks' notice, these patients were informed that they could no longer obtain medical care at the hospital or visit their physicians who worked at the hospital. The feeling of mass abandonment was terrifying—these patients feared not only for the loss of their continuing care and their relationship with their usual physician but also feared for their future medical care.
In today's society, few patients pay directly for their medical care; most rely on a third party, be it insurance or a prepaid plan. Unfortunately, unless patients have direct control over the financial aspect of their medical care, institution-initiated abandonment will continue.
Henry P. Kafka, MD, FRCPC
National Defence Medical Center; Ottawa, Ontario KIA 0K6; Canada
Disclaimer; These opinions are those of the author and do not necessarily represent those of the Department of National Defence, Canada.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
