Medical care practitioners treating prisoners must respect their patient’s
autonomy, within the bounds of prison regulations.
Prisoners have the right to consent to and refuse medical care, but these
rights are limited.
Team physicians must always put the interests of the player first.
Team and school physicians must be aware of the special duties
involved in treating minors.
School physicians must respect their patient’s privacy and the parents’
right to oversee their children’s care.
Institutional practitioners are medical care practitioners who work for an entity
whose interests are sometimes adverse to their patients’ interests. The most
common institutional practice is occupational medicine. This section discusses
prisons, sports teams, and schools. These represent a continuum, with prisons
having the greatest conflict between the institution and the patients, and
schools having the least. When medical care practitioners practicing in these
environments balance their duty to the patient against their duty to the
institution and the community, they must not confuse public safety issues with
institutional convenience. For example, prison health care practitioners should
not drug patients just to keep them quiet, but must not hesitate in diagnosing
and treating communicable diseases that may spread in the prison setting.
School physicians face the same dilemma when requested to recommend
Ritalin to quiet an unruly student.
The team and school physicians share the conflict between institutional
obligations and the fiduciary duty to the individual patient. This conflict is
exacerbated because many patients are unable to make knowing choices of
treatment. Often the patients are minors. In others, the coercive atmosphere of
team sports makes it difficult for individual athletes to resist the pressure to
compete when it is medically inadvisable. School and team physicians must be
careful to protect their adult patients’ autonomy. When the patient is a minor,
the physician may have to intercede to protect the child from the pressure of
overly competitive parents and coaches.