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Stephanie Rebeiro
Professor Muser
Phil 4400
March 9, 2012
Freedom of Choice
There are many cases throughout medical history that bring up the question of morals or
ethics. This matter not only applies to the actions of doctors and nurses, but also to patients
themselves. To help avoid ethical battles in the medical field the American Medical Association
has adopted a set of 9 codes known as the Principles of Medical Ethics which lay out duties and
standards for physicians to endorse. Although all ethical codes were developed to benefit both
patients and others in the medical field, when looking at the similarities and differences between
codes VI and VIII, ethical code VI provides better action guidance in Horns Refusal to
Participate case study.
Ethical code VI from the American Medical Association states, A physician shall, in the
provision of appropriate patient care, except in emergencies, be free to choose whom to serve,
with whom to associate, and the environment in which to provide medical care. This particular
ethical code protects both physicians and patients. According to this statement a physician has
the right to refuse to give service to anyone so long as it is not an emergency and also as long as
there are other physicians available to care for the patient. This ensures that no patient will be left
untreated and that a doctor can only choose not to serve the patient if another physician is wiling.
Ethical code VI binds the physician to a responsibility to emergency situations as well as
provides him or her with a right to make choices within their medical career regarding to whom

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and where service is given. This code also protects the patient by assuring them that a doctor can
only turn them down if there are enough others available to give proper care.
Ethical code VIII states, a physician shall, while caring for a patient, regard
responsibility to the patient as paramount (AMA). This indicates that the patient will come first
before anything else that the doctor acquires while caring for them. According to this code, even
if an emergency was presented to that doctor, all duties to the patient override care of anyone
who is not directly under the physicians supervision. It is important to note that this standard of
conduct only applies to patients that are already being cared for by the doctor. This code is
clearly for the benefit of the patient.
Ethical codes VI and VIII deal with two completely different aspects in the medical field.
First, ethical code VI gives entitlement to the doctors to choose who to serve, associate with, and
the situations to work in. On the other hand ethic code VIII states that a physician has overriding
responsibility to his or her patients. These two statements seem to contradict each other, what
allows both of these codes to work at the same time are the words, while caring in code VIII.
Physicians who have already began care with a patient have to hold accountability to them over
anyone else, but if the doctor has not already associated with a patient then he or she has the right
to choose who to serve.
Another difference between the two codes is the matter of emergency cases. According to
ethical code VI emergency cases are to be taken whether or not the physician wishes to give
service to the patient and also whether or not he or she prefers the environment. On the other
hand ethical code VIII ensures that the care of an existing patient will remain supreme; he or she
may not abandon the patient for another case. It is possible for a physician to have multiple
patients and still respond to the emergency so long as the care for current patients is not affected

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in any way.
Horns Conscientious Refusal to Participate in a Procedure case study is an example of a
moral dilemma that may be able to be resolved with the help of the American Medical
Associations ethical codes of conduct. In this case study a nurse is in conflict with the
sterilization surgery of an institutionalized, severely mentally retarded fifteen year old girl
(Horn). The doctor and the parents of the teenager are both in favor of the surgery, but the nurse
feels otherwise. The nurse disagrees with the surgery because she is against sterilization, due to a
religious conflict, and also because the girl has not given consent. The doctor feels that
repercussions may be needed based on the fact that she is on the threshold of patient
abandonment (Horn). The question in this case is whether the nurse should participate in the
surgery, or stick with her beliefs and make the doctor find someone else to help with the surgery,
while risking the threatened consequences.
For the answer to this moral dilemma physicians can look to the codes of ethics. The two
ethical codes that best relate to this situation are the ones previously discussed, but each code
takes a different stance. When looking from the point of view of Ethical code VI, the nurse has
the choice to decide whom to associate with and whom to serve. First, the nurse has already
chosen to associate with this doctor, whether or not she knew that he or she was not against
sterilization. Second, the code says that the nurse has the right to choose who to serve. This
statement comes with two exceptions though. The first exception is in cases of emergency. In the
case study there was not a sense of urgency to do the surgery and it was never mentioned that the
sterilization was an emergency situation, so the nurse is still free to choose whether to participate
in the surgery or not. The second exception is in the provision of appropriate patient care. When
reading the case study it appears that the doctor may be working in a private practice with a

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limited amount of help. In the case that there was no one else to help with the surgery the nurse
would be obligated to participate, but the doctor reluctantly mentions another option. The
physician mentions that they would have to hire a temporary nurse if she chose not to partake in
the surgery. Because the doctor even mentioned this option, makes it sound like a viable choice.
Now that the case is not an emergency and there are means of appropriate patient care the nurse
has the choice of whether or not to participate in the sterilization of the girl.
When looking at the situation from the point of view of ethical code VIII, a physician
must regard responsibility to the patient as paramount (AMA). This means that even though
the nurse is morally against sterilization she still has a responsibility to the girl. But there is one
part that still needs to be considered. This code would only apply to the nurse if the girl was
currently under her care. Because the case study did not mention that the nurse has been taking
care of the girl prior to the thought of the sterilization surgery, it cannot be assumed that the
nurse falls under the conduct of this particular code. Ultimately she holds no responsibility to this
patient.
After looking at the case study regarding both ethical codes, it is clear that code VI
provides the greatest amount of action guidance. Overall, in this particular case, the nurse retains
the choice of whether or not to participate in the sterilization surgery. The fact that the doctor
threatened her with consequences may hinder her from using this code to its fullest capability in
this situation, but in the end the choice is hers. These codes adopted by the American Medical
Association are pertinent to both the patients and the physicians in the medical field, providing
guidance and standards of conduct to benefit the society.

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Works Cited
American Medical Association. Principles of Medical Ethics. June 2001. Print.
Horn, Peter. Clinical Ethics Casebook. Wadswoth/Thompson Leaning. 2003. Print.