Does Free Speech Apply to Doctors?

April 3, 2010 in Medical Ethics, Medical Legal by RangelMD

Specifically, does the protection of the first Amendment apply to doctors who espouse conservative beliefs in signs on their office windows? Florida urologist Jack Cassell recently placed a sign on the window of his office that read, “If you voted for Obama … seek urologic care elsewhere. Changes to your healthcare begin right now, not in four years.

Of course, the liberal war machine when into high gear once word of this got out.

“Cassell may be walking a thin line between his right to free speech and his professional obligation”, said William Allen, professor of bioethics, law and medical professionalism at the University of Florida‘s College of Medicine.

The outspoken [U.S. Rep. Alan Grayson], described Cassell’s sign as “ridiculous.” “I’m disgusted,” he said. “Maybe he thinks the Hippocratic Oath says, ‘Do no good.’ If this is the face of the right wing in America, it’s the face of cruelty. … Why don’t they change the name of the Republican Party to the Sore Loser Party?”

To his credit, Dr. Cassell denies having abandoned or refused to treat patients based on their political views and denies even asking patients about their views or who they voted for as a

The Oath: It's Greek to me.

prerequisite for treatment.  Dr. Cassell’s sign is obviously a political statement and not a serious policy if considered in the context of the fact that voting remains by way of secret ballot in this country and that other then bumper stickers there is no way to identify the political affiliation or opinions of Americans.

Rep. Grayson is right about one thing. Taking this sign seriously is about as “ridiculous” as literally believing the intentions of a doctor who puts up a sign stating their refusal to treat anyone who’s favorite color is blue.

But don’t raise such practicalities of common sense with Mr. Grayson who has threatened to file a complaint against Dr. Cassell with the Florida Department of Health.  This is just another perfect example of why the first amendment continues to be so important (actual and real patient abandonment should be irrespective of the reasons for such ethics violations).

This case does raise a troubling issue. Are physicians for all intents and purposes, stripped of their rights to political speech and political activity if such activity directly involves patient care? One of the letters to the editor of the Orlando Sentinel expressed disgust at Dr. Cassell’s mixing of politics and patient care while ironically stating her right to choose another physician if faced with a similar sign. Wait. Don’t doctors also have the right to choose to be politically active just as patients have the right to pick and change doctors?

Though ivory tower bioethicists believe that the Hippocratic Oath binds physicians to an unbreakable doctor-patient relationship until death do us part or until the patient seeks care elsewhere, the fact is that there is nothing in the Oath that specifically forbids political activity by doctors nor compels them to treat a patient indefinitely irrespective of any reason to end the relationship. Practicalities take priority over idealism in common law.  Except for laws that bar discrimination, a physician is allowed to refuse service or to terminate services. In almost all cases, physician’s are allowed to end a professional relationship with a patient after giving appropriate notice and assistance as indicated to help the patient secure care elsewhere while being available for a practical time period to render emergency care as needed.

Ideally, political activity should NOT impact or compromise patient care but sometimes a work stoppage (strike) and refusal to participate in the system is the only way to send an effective message. Nor should doctors be forced by some false interpretation of the Hippocratic Oath to continue to provide care within a health care system that they feel compromises their own economic stability and/or the ultimate care of their patients. In other words, do the ethical constraints of the Hippocratic Oath trump the Constitutional rights of physicians? Absolutely not. The Framers were well aware of the ancient Oath in their time and did not choose to make an exception in that the rights of patients for care would negate the speech and political rights of their physicians.

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