Depending on the institutional policy, the generic imposition of American Hospital Association (AHA) states that the patient, despite of being under the contracted patient-provider relationship, may request the termination of patient-provider relationship based on the patient’s consumer rights, while the provider may only terminate the set contract based on ethico-legal grounds (Servellen, 1997 p. 335).
If termination of relationship has been approved, the patient is still entitled to the following elements of the contract: (1) health care provider’s duty to provide continuous care, (2) fulfilling the expectations of care for the patient, and (3) carrying out the obligations of care (Mason, 2004 p. 307).
Termination of care may be considered as an alternative for failed health care partnership; however, another angle to analyze, regardless of the causes of termination, is the ethics associated in this decision. As imposed by the U. S. Preventive Service Task Force, a provider under the legal contract of patient-provider relationship, by default of agreement, agrees to the following conditions of relationship setting (Capezuti, Capezuti and Siegler, 2007 p. 614):
“(a) understands the risks associated with the disease or condition, (2) understands the treatment options, including risks, benefits, alternatives and uncertainties, and (3) considers the potential risks and benefits associated with treatment in the context of his or her personal values, and (4) has engaged in decision making at a personally desired and comfortable level”. Upon signing the endorsement form, the provider immediately acknowledges the capacity to maintain, deliver and establish partnership care with the patient.
If in case the provider shows reluctant behavior or incompetence during care process, the provider maybe sued legally under the violations of breach of duty and professional incompetence. Despite of the transactional relationship established after the establishment of contact, the provider needs to consider the nature of non-equalitarian partnership imposed in the nature of patient-provider relationship; rather, leading, establishment of rapport and serving the best interests to as the patient as the care provider must all be considered (Shamus and Stern, 2003 p. 74).
From the ethical principle of duty and ole fidelity, the provider needs to render continuous and uncompromised care to the patient. The 1996 Health Insurance Portability and Accountability Act (HIPAA) implemented by the congress under Public Law No. 104-191, Stat. 1936 aims to protect and secure the patient’s level of care received from their provider most especially for contract-set patient care (Lauwers and Swisher, 2005 p. 532).
The act centers in protecting the patient records from unauthorized personnel claiming the information of patient engaged in a health care regimen or transaction; however, according to Abood (2008), HIPAA also ensures the fulfillment of care quality received by the patient from their providers (p. 262). According to Earp, French and Gilkey (2007), patient-provider relationship is expected to work as an enhancing strategy for patient’s trust towards their health care provider (p. 195).
On the other hand, if conflicting behaviors, such as non-compliance, angry behavior, mistrust, still occur on the patient despite of the care regimen being provided by the provider, the patient or the provider may request the termination of relationship in accordance to the guidelines imposed by the institution. In case the patient becomes notoriously incompliant despite the continuous care regimen provided by the assigned provider, AMA suggests a series of assessment for the noncompliant behavior without involving one’s professional role outside the scope of care provision (e. g. patient’s financial burdens, family problems, etc. ) (Mason, 2004 p. 307).
Provider’s duty of care starts after signing the endorsement forms and can only be terminated under justified grounds of patient’s response to partnered relationship. As imposed by the AMA Code of Ethics in 1998 Doc #1, p. 5, “physicians (health care providers) cannot withdraw from a case without giving notice to the patient, the relatives, or responsible friends sufficiently long in advance of withdrawal to permit another medical attendant to be secured” (cited at Rothestein, Brody and McCullough et al. , 2001 p. 621).