Eyeworld

113 OPHTHALMOLOGY BUSINESS October 2015 er welfare can only be decided by ap- peals to "reasonability." The patient who needs care but who presents some degree of danger to the health professional requires calculating how to accomplish the most good or the least harm along with whatever legal and ethical obligations apply. In my experience, these cases are best resolved by groups, like an eth- ics committee, because they often involve so many variables whose complexity overwhelms any one person's knowledge and experience. Also, the more complex the prob- lem, the more a solution is likely to be tentative or be only applicable to that case. Regarding pediatricians faced with unvaccinated children, for example, the current wisdom suggests that physicians remain free to deny care to unvaccinated kids, but that they should conspicuously advertise their positions, especially if they treat unvaccinated children, so as to inform current as well as prospective patients and their fam- ilies (who might want to take their unvaccinated infants elsewhere). Back in sunny Florida, however, Dr. Cassell appears to continue his opposition to the Affordable Care Act. Whether or not he has gone too far in suggesting that Democrats get their urologic care elsewhere I'll leave to others to debate. But as one individual remarked, Dr. Cassell may have performed a valuable service by announcing his disaffection with Democrat voters so publicly: If I seek him out to care for a urologic prob- lem I'm having, I'd certainly know to keep my political sentiments to myself! EW frustration over a possible mone- tary loss. In other, more routine, non-emergent clinical situations, the literature generally understands a physician to be entirely within his or her rights to refuse care to a prospective patient who cannot demonstrate an ability to pay. While turning patients away may be very upsetting among ophthalmologists —such that many of them formally allocate a percentage of their time to pro bono work—physicians are usu- ally not obligated to take a financial loss in caring for patients, unless the kinds of statutory, contractual, or tort considerations described above apply. Lastly, what about a patient who presents a considerable threat to the welfare of the health professional or his or her staff? I can tell you that not every health professional at Emory University Hospital was enthusiastic about admitting pa- tients infected with the Ebola virus in 2014. So, when Emory made the institutional decision to treat these patients, what ethical obligations applied to Emory staff to care for them? Could reluctant physicians or nurses—who perhaps didn't so much fear for their own welfare but rather for the welfare of their fam- ilies or other patients—be given a pass without any institutional fuss? (Answer: Yes, Emory's Ebola caretak- ers volunteered.) And while Emory Hospital maintained a specialized unit and exquisitely trained staff to deal with extremely infectious diseases like Ebola, what about a private physician practice that isn't nearly so resource rich and believes that a particular patient or patient group presents an inordinate risk to other patients or staff? I have never favored ethical "resolutions" that, after a long and exhaustive analysis, ultimately say something like, "In such cases, the decider must simply rely on his or her best judgment." But I'm afraid that so many cases posing a serious conflict between patient and provid- Advancing Diversity in Leadership. Join us for the OWL Signature Event at AAO Keynote Speaker: Kjerstin Gruys, PhD Saturday, Nov 14th | 5:30 - 7:00 pm The Wynn, Latour Ballroom 3 • OWL members are invited to attend these Interest Group Sessions at AAO Rising Stars In Ophthalmology Friday, Nov 13th | 2:00 - 3:00 pm The Venetian, Toscana Rm 3706 Ophthalmic Industry Professionals: "Owning Your Career Pathway" Presenter: Diane Houtman Friday, Nov 13th | 2:00 - 3:00 pm The Venetian, Toscana Rm 3708 Professionals In Practice: "QRUR's and VBM's: How VBM's will impact Ophthalmology" Presenter: Dr. Scott Eccarius Friday, Nov 13th | 4:00 - 5:00 pm The Venetian, Toscana Rm 3706 Ophthalmic Business Owners: "Focus on Impact" Presenters: Ellen Troyer and Cynthia Barrat Friday, Nov 13th | 4:00 - 5:00 pm The Venetian, Toscana Rm 3708 Interest Group Networking Reception Friday, Nov 13th | 3:00 - 4:00 pm The Venetian, Toscana Rm 3707 Visit www.owlsite.org for details and to register for the event or sessions. Dr. Banja is a professor and medical ethicist at Emory University, Atlanta, and a former member of the ASCRS Governing Board. Readers are invited to send comments or cases to him at jbanja@emory.edu. About the author

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