You’ve been Mary’s physician for 10 years. She is now 28 years old with two young children and a recent divorce. Mary came to you depressed last year because she felt isolated, was unemployed, and didn’t want to become welfare dependent. She seems much happier today when she sees you, because she’s excited to tell you she’s had a fairly well paying job for the last 4 months. She works at an employee-friendly domestic cleaning service.
Mary tells you that her childhood asthma, which she had kept under control, has become exacerbated on the job because of the cleaning products she has to use. Her employer noticed her concerning coughs and wanted a physician to check on her, to clear the company of any liability they have for her health. She has a form for you to fill out regarding her physical wellbeing. Mary begs of you to clear her for the job and promises to wear a mask over her nose and mouth from now on. She says she’s likely to be fired and lose her decent income if you document her asthma’s exacerbation.
Define the ethical issues involved and describe what you would do as her physician.
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I'm having a difficult time seeing the conflict here. Obviously it is not great for her health that the cleaning products are exacerbating her asthma, but if she wears a mask from now on the effects will be mitigated. Since this is an employee-friendly company, she could also discuss with her boss what other types of cleaning products she could use instead. In addition, there are certainly effective treatments for her asthma that we could start her on, such as a long-acting beta2-agonist inhaler or inhaled corticosteroids. As to documenting it- her employer does not have a right to see her medical record due to HIPAA, so I would definitely note the exacerbation in her chart so that I could treat her and bill her insurance for the treatment. All her doctor is being asked to do, if I am understanding this correctly, is to sign a medical clearance form saying that she can do her job. Its pretty clear to me that she can do her job with only a few cheap modifications that should not bother her employer in the least. Maybe someone else can write in and explain where the conflict is. Personally, I would sign the form with a clear conscience.
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