Treatment for relatives and friends: yes or no?

Advice for the aunt, a prescription for the mother, a check-up for the best friend. Physicians occasionally treat their friends and relatives. Is it a good idea?

Study overview

A difficult dilemma

Medical enquiries from relatives and friends can present physicians with a dilemma. On the one hand, they want to help people close to them, but on the other hand, they see themselves as being caught in a possible conflict situation. Behind this is a normative-ethical question that is not easy to answer.

Francisca Beigel and her team from the Institute for Ethics, History and Philosophy of Medicine at the Hanover Medical School, Germany, looked for arguments for and against this common practice. In doing so, they found reasons on the micro and macro levels of human relationships. While micro-sociology examines social interactions at the personal level, for example in direct physician-patient contact, macro-sociology describes larger social structures such as the health care system as a whole.

Pro: trust and the best possible treatment

On both levels, the researchers found weighty arguments for and against the treatment of close relatives.

On the micro level, the high level of trust and the desire for the best possible care speak in favour. On the macro level, expediency plays a role. Direct treatment by a medical friend or family member can facilitate access to medical care and help overcome barriers to care.

Contra: lack of objectivity and issues of patient autonomy

On the other hand, a close personal relationship between physician and patient also raises ethical problems. From a micro-sociological point of view, a lack of objectivity is often cited. Medical confidentiality, informed consent and patient autonomy may also be at risk. In addition, cutbacks in the physical examination and compromises in therapy can reduce the quality of treatment. Macrosociologically, it becomes problematic when the physician favours his relatives and friends and neglects other patients.

Guidelines are cautious

The few ethical guidelines on the subject, such as those of the American Medical Association (AMA), the Australian Medical Association and the Canadian Medical Association, are rather cautious and generally advise physicians against treating people close to them. However, there is agreement on certain exceptions. These include emergencies, the lack of availability of physicians in remote areas, and minor illnesses. Here, treatment by the physician relative or friend can be useful.

Conclusion for medical practice

Although a large proportion of physicians state that they have already treated relatives or acquaintances, the majority of the literature and relevant guidelines advise against it. A universal answer to this question will hardly be found, as the respective circumstances are too individual and different. Nevertheless, a broad ethical discussion is necessary so that physicians can make ethically sound decisions in this sensitive area.