Assignment task:
For years, Jeff visited a free clinic that provided health care to uninsured persons. He had established a relationship with Dr. A, who always inquired about Jeff's smoking habits and advised him to quit or at least curtail his smoking. Despite repeated warnings and failed attempts at using medications to stop smoking, Jeff continued to smoke heavily, eventually developing signs of emphysema in his early fifties. Now, at age 57, Jeff continues to smoke and has developed a severe case of emphysema. He goes frequently to the clinic--sometimes for clear medical reasons but sometimes apparently just to talk. The clinic meanwhile has been hit with waves of COVID patients and budget cuts that have resulted in fewer staff to see patients. During one of Jeff's drop-in visits, he speaks with a nurse practitioner who states that Jeff needs multiple laboratory tests not available on site and depending on the results, he may need surgery. Two weeks later when Jeff returns for an appointment with Dr. A., the physician is irritated with Jeff for ignoring all warnings and worsening his own medical condition. Dr. A. tells him that, in the future, he must call before coming to the clinic and that there might not always be a staff member available to see him. Dr. A adds, "These days I am very busy with long haul COVID patients--patients who need critical care interventions--and by the way, I will be unable to see you for any future appointments."
1. To what extent is Jeff responsible for his severe case of emphysema resulting in the need for potentially expensive procedures he is unable to pay for and that limit health care resources available for other patients?
2. Based on the practice guidelines of the clinic for an acceptable standard of care, does Dr. A. have an obligation to continue to be available to Jeff?
3. How is Jeff's care being affected by the post-COVID crisis?