Opinion ID: 1917662
Heading Depth: 1
Heading Rank: 5

Heading: Maintaining the Integrity of the Medical Profession

Text: The Commissioner cites Polk as authority to support his claim that the ethical integrity of the medical profession has been impaired by Reid's refusal to submit to kidney dialysis. See Polk, 594 N.W.2d at 428 (holding that the ethical integrity of the medical profession was impaired by permitting the inmate, Brown, to refuse kidney dialysis). In addition, the Commissioner contends that Reid's ill-informed refusal to accept standard medical treatment for a set of non-terminal conditions impairs the ethical integrity of his physicians. The Court of Special Appeals stated that it failed to see how the medical profession has been harmed by Reid's refusal to accept treatment, and likewise, so do we. The intermediate appellate court reasoned: [T]he circuit court found that [Reid] is a competent adult who has expressly stated his desire to forego medical treatment he finds objectionable. [The Commissioner] has neglected to illuminate any ethical dilemma on which to base his argument. Medical professions continue to provide ... diagnoses and continue to attempt to treat patients with no question as to their ethics or integrity. Furthermore, in light of the well-defined right of an individual to refuse medical treatment, discussed supra, and having been provided no authority by [the Commissioner] to indicate otherwise, we hold that the ethical integrity of the medical profession is not harmed by allowing [Reid], a competent adult, to refuse medical treatment. Stouffer, 184 Md.App. at 285, 965 A.2d at 106. The Iowa Supreme Court in Polk determined that preserving the ethical integrity of [the medical professional's] recommendation [of treatment] also favors [the] decision to compel treatment because if Brown would voluntarily submit to dialysis treatment, his submission would be consistent with the medical professionals' recommendation in helping to prolong Brown's life. Polk, 594 N.W.2d at 428. In our review of that opinion, we are not persuaded that Brown's refusal to submit to kidney dialysis had any effect on the integrity of the medical profession. In the present case, merely because health care professionals recommended kidney dialysis or other treatment for Reid, and he rejected that recommendation, his rejection did not harm the integrity of the medical professional. An inmate, by virtue of his incarceration, is not divested of his right to disagree with his medical providers. Although Reid has both a common law and constitutional right to refuse unwanted medical treatment, Mack, 329 Md. at 210-11, 618 A.2d at 755; see also Cruzan, 497 U.S. at 277, 110 S.Ct. at 2851, 111 L.Ed.2d at 241, in the present case we base our decision on Reid's common law right to refuse medical treatment and therefore need not reach the constitutional question. As noted by courts in other jurisdictions, a patient's right of self-determination, ordinarily, is superior to the considerations of the medical profession as to treatment options. See Thor, 21 Cal. Rptr.2d 357, 855 P.2d at 386 (noting that patient autonomy and medical ethics are not reciprocals; one does not come at the expense of the other); Myers, 399 N.E.2d at 458 (noting that the interest in maintaining the integrity of the medical profession is not controlling because a patient's right of self-determination would normally be superior to ... institutional concerns of the government and medical profession). The Commissioner also asserts that the trial court's written finding that Reid's refusal of treatment did not affect the integrity of the medical profession contradicts the court's oral findings and is clearly erroneous. Based upon our review of the record, we fail to see any contradiction in the written findings of the trial judge and his oral pronouncements. In addition, the court's written findings of fact are not clearly erroneous. The court acknowledged that Reid rejected the advice and efforts of his physicians, and that the physicians believed that Reid's treatment was necessary. Ultimately, the trial judge concluded that Reid's refusal of treatment did not affect the integrity of the medical profession. In the present case, there was appropriate consultation by medical providers with Reid concerning his treatment. After consultation, Reid rejected the recommendations of his physicians. On the basis of this record there is no violation of the integrity of the medical profession. Moreover, the record supports the trial judge's factual findings.