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Medicine and Public Policy |

Nonabandonment: A Central Obligation for Physicians

Timothy E. Quill, MD; and Christine K. Cassel, MD
[+] Article and Author Information

From the University of Rochester School of Medicine, Rochester, New York. University of Chicago School of Medicine, Chicago, Illinois. Requests for Reprints: Timothy E. Quill, MD, Department of Medicine, The Genesee Hospital, 224 Alexander Street, Rochester, NY 14607. Disclaimer: The authors' views on this subject do not necessarily reflect those of the University of Rochester or its Department of Medicine. Acknowledgments: The authors thank Cynthia, her family, and Mrs. K for allowing us to share their stories; Penny Townsend Quill; the members of Rochester's Fellowship Medical Writing Seminar (Gary Bischof, Laura Brachman, Al Daniels, Martha David, Mike Eisman, Steve Kelleher, Naomi Pless, and Asher Tulsky); and Maria Milella for her help in manuscript preparation.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1995;122(5):368-374. doi:10.7326/0003-4819-122-5-199503010-00008
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Nonabandonment is one of a physician's central ethical obligations; it reflects a longitudinal commitment both to care about patients and to jointly seek solutions to problems with patients throughout their illnesses.The depth of this commitment may vary depending on the physician's and the patient's values and personalities, their shared experiences, and the patient's clinical circumstances. Traditional principled ethical analyses must balance the personal histories, values, motivations, and intentions of the participants with more general considerations. Such analyses often focus on a particular act, isolated in time, and yet the consequences of one decision immediately lead to a new set of choices. Nonabandonment places the physician's open-ended, long-term, caring commitment to joint problem solving at the core of medical ethics and clinical medicine. There is a world of difference between facing an uncertain future alone and facing it with a committed, caring, knowledgeable partner who will not shy away from difficult decisions when the path is unclear.

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Cherry Picking clients
Posted on January 21, 2008
Kevin D. Kvisle
-
Conflict of Interest: None Declared

Although the article may have been about end-of-life, there is an occasional abandonment of patients that do not fit the profile of the types of patients a doctor prefers to have as clients.

Opiate dependent patients are commonly excused from GPs offices in the area I live in. Such patients have often been problematic for doctors, but not all are. It is clearly discrimination to lump them all together as being problematic, and is therefore inexcusable to simply say "this clinic does not service opiate dependent patients".

Conflict of Interest:

None declared

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