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Two of the most important principles in dealing with patient requests are being upfront about the issue and respectful of the person.

What happens when a woman in labour requests female-only health-care providers?

For The Ottawa Hospital’s Department of Obstetrics, Gynecology and Newborn Care, this is not uncommon. They use two important principles to guide them for all patient requests: be upfront about the issue and be respectful.

“The patient’s obstetrician in the community explains the realities of the hospital – nursing shifts and physician call schedules – and has the patients sign a form acknowledging that this request can’t be guaranteed,” said Rosaleen Rowe, Care Facilitator for the Birthing Unit at the Civic Campus. “When they arrive, we do all we can to accommodate their requests, but patient safety is paramount, and if we can’t accommodate them, we try to minimize the impact as much as possible.”

Navigating the grey area of these ethical dilemmas is what Dr. Tom Foreman, Director of Clinical and Organizational Ethics, does every day. Requests include health-care providers of a specific sex or race, cultural rituals that require burning something in a patient room, refusing transfusions, not eating during religious holidays, refusing treatment in favour of a natural remedy, and many more.

“We accommodate when we can, but the real challenge is that not all of these ethical issues are solvable,” said Dr. Foreman. “If patients have the capacity to make their own decisions, even if the implications of their choices may be morally distressing to staff, does that negate the patient’s right to do it?”

Dr. Foreman, who heads the Ethics Consultation Service, emphasizes two questions: is the request reasonable and is it feasible?

“Some of these requests are unique,” said Dr. Foreman. All questions about accommodation must start from a position of respect. Although not all accommodations can be made, there may well be opportunities to creatively meet requests:

• Some cultures value having large extended families present to support and accompany patients during their end-of-life journey. In these cases, it may be reasonable to allow a larger-than-normal number of visitors, as long as other patients’ needs for privacy and quiet are respected.
• Some patients may prefer, for cultural or religious reasons, to have a gender-specific or ethnically-specific care provider. While we may be able to accommodate these requests, there may be circumstances where we cannot.

“The challenge is to achieve a balance between the request and the clinical reality,” said Dr. Foreman. “And the keys to achieving that balance are being aware, respectful, communicating clearly and utilizing the available support services.”

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