Politics in Practice: Intense Conversations in Intensive Care

By Erin Talati

As Holly Lynch describes in her recent post, the upcoming election brings a number of bioethics questions directly to the public. Two of the three ballot questions in Massachusetts invite discussion and debate on the controversial issues of physician-assisted suicide and the medical use of marijuana. The introduction of these issues as ballot initiatives offers physicians the opportunity for rich discussion on important topics with their patients. But, how much should physicians and other health care providers share with patients regarding their own views on these issues?

In encouraging communication between doctor and patient on relevant public policy issues, the AMA Council on Ethical and Judicial Affairs 1998 report, “Physicians’ Political Communications with Patients and their Families,” indicates that such communications are also potential points for patient vulnerability.  The Council writes that, “[w]hile physicians have the right and responsibility to communicate with their patients and their families about political matters, such communication must be undertaken with sensitivity to the threats that such communication can pose to the patient-physician relationship.” The report suggests that these conversations should be avoided when patients or families are “emotionally pressured by significant medical circumstances.”

Health care providers working in medical, surgical or neonatal intensive care units, like myself, may find it difficult to interpret the AMA’s guidance on the issue of communication about political questions with patients. In the ICU, almost all patients and their families are “emotionally pressured by significant medical circumstances.”  These circumstances may further distort the balance in the physician-patient relationship, as patients and families often feel helpless and even more dependent on the knowledge and advice of providers to guide them through immensely difficult decisions. Some might argue that these conditions make discussions on politically charged issues completely inappropriate in this setting. Yet, these are the same families who may be living in circumstances relevant to the proposed ballot initiatives, and who may look to physicians for guidance on interpreting these issues.

My colleagues and I faced this situation earlier this week when asked directly about our opinions on health care reform with reference to the upcoming election. I stood silently for a moment, hoping the discussion would not turn to a question about the proposed Massachusetts ballot questions, worried that this conversation might be overheard by other families in the ICU who were facing very real questions about the life or death of their loved one. We steered the family who was asking into a private room and cautiously turned the conversation towards their concerns, admittedly avoiding a direct response to the question. Still, the situation has me thinking about what a health care provider should do in this situation. If instead we were asked our thoughts on ballot question 2, would it have been appropriate to respond?

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