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AMA J Ethics. 2019 Jan 1;21(1):E26-31. doi: 10.1001/amajethics.2019.26.

How Should Clinicians Respond When Different Standards of Care Are Applied to Undocumented Patients?

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A general internist at Yale Internal Medicine Associates in New Haven, Connecticut.
An associate professor and the associate director of the Program for Biomedical Ethics at Yale School of Medicine in New Haven, Connecticut.


A challenge in caring for patients in resource-poor settings is the ethical discomfort and discouragement clinicians might experience when they're unable to provide optimal care due to lack of resources. This case, in which a resident is faced with rationalizing substandard care for certain classes of patients, probably represents the top of a slippery slope. This article argues that physicians should identify and advocate for optimal care for each patient. Moreover, physicians should advocate to improve the health system that allows for substandard care. Physicians should disclose to patients all available evaluation and treatment options, even those that seem cost prohibitive or unrealistic for some other reason. Transparency and objectivity in the patient-clinician relationship require good communication skills and are central to avoiding harm.

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