Healthcare Refusal: A Case Study on Discrimination and Ethics

This case study critically examines a situation where a paediatrician, Dr. Roi, refused to provide medical care to a baby of a lesbian couple due to her religious beliefs against homosexuality. The analysis identifies key issues such as discrimination based on sexual orientation, unequal treatment of patients violating Equality Law, breach of healthcare rights, and a lack of diversity recognition within the healthcare system. It draws upon theories related to equality, diversity, social justice, and sexual orientation to explain these issues. The study references the Equality Act 2010 and the Health and Social Care Act 2008, highlighting legal aspects and potential violations. It also considers the complexities of balancing religious freedom with professional duties, referencing the European Court of Human Rights decisions. The conclusion emphasizes the need for stricter laws and clear guidelines to prevent discrimination, proposing that the NHS should clarify when sexual orientation information is relevant to treatment. Ultimately, the analysis advocates for ensuring equal access to healthcare services for all individuals, regardless of their sexual orientation, and stresses the importance of addressing the identified issues to promote a more inclusive and equitable healthcare environment. Desklib provides access to similar case studies and resources for students.

Running head: CASE STUDY ANALYSIS
CASE STUDY ANALYSIS
Name of the student
Name of the university
Author note

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Introduction
The paper analyses the case study involving one Dr. Roi, a paediatrician who had refused
to provide medical care to a baby belonging to lesbian couple because it was against her “anti-
gay religious beliefs”. Due to her refusal, the same-sex couple had to consult another
paediatrician. After four months, Dr. Roi sent an apology letter to the couple but did not
withdraw her refusal to provide care to the baby.
The aim of this paper is to identify the problems or issues in the above case by making
use of relevant theories and concepts. Certain theories and concepts shall be used to explain the
issues and provide solutions for the same. These include equality, diversity, social justice and
sexual orientation theory. the paper argues that proper outlining of the laws regarding religious
beliefs being practiced in the workplace and the rights of the patients must be done to ensure
equality in healthcare.
Description
From the case study, it is clear that the paediatrician has discriminated against the patient
because of the sexual orientation of the parents. Further issues in the case study also include the
unequal treatment of patients thus breaking the Equality Law based on sexual orientation, breach
of healthcare rights, and lack of diversity recognition.
Discussion
Dyer and das Nair (2013) have found in a systematic review that there is a major absence
of awareness amongst healthcare workers about the lesbian, gay or bisexual people and their
needs. The review found that these healthcare professionals need proper training so that they

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could understand the the needs of these people with different sexual orientation. Due to lack of
this knowledge, the healthcare professionals often engage in discriminatory practices against the
patients (Ageuk.org.uk 2019). The given case study is a good example of such discrimination.
Baillie and Matiti (2019) report that the lesbian and bisexual women are discriminated against
because the healthcare workers do not realize that these women are marginalized and come under
the minority group. When Dr. Roi refused to care for the lesbian couple’s baby, she exemplified
the highest level of discrimination based on sexual orientation without realizing the implications
it would have on the baby. The baby had to be treated by another paediatrician in a short time
and apart from that, the parents had handpicked Dr. Roi for their baby but her refusal put the
baby’s life at risk. According to the General Medical Council ethical guidelines in terms of
personal belief, “all patients must be treated with respect and not be unfairly discriminated
against” (Gmc-uk.org 2019).
The next issue that has been identified is the unequal treatment of the patient based on
sexual orientation. Hayman et al. (2013) observe that such inequality in healthcare service
hampers the overall wellbeing of any nation and there has to be strict repercussions for those
who fail to provide equal treatment. Dahl et al. (2013) further inform that such inequality triggers
or escalates other health problems, most likely mental health problems. The refusal by Dr. Roi
would not only cause deterioration of health for the baby but also make the parents feel
depressed and psychologically stressed. The issue of inequality in the health sector based on
sexual orientation in England is even encouraged by the most prestigious NHS. As per the new
new guidelines of the NHS, health professionals must ask about the sexual orientation of their
patients aged or above 16 years (Bbc.com 2019). According to NHS, doctors and nurses also fall
under the guidance along with the local councils who are responsible for providing social care to

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adult people. Although the NHS cleared that the patients would not be forced to answer but if
they do, it would help in ensuring that “no patient is discriminated against” (Bbc.com 2019). The
news about the NHS releasing new guidelines for healthcare professionals including doctors to
ask about patients’ sexual orientation created controversy across England. The guideline has
been opposed by several organizations and associations including the Family Doctor Association
according to which, it was “potentially intrusive and offensive” (Bbc.com 2019). As evident
from the case study, the revelation of sexual orientation of the parents led to the refusal of
treatment for their baby by the paediatrician. However, many LGBT Q organization founders
working with the NHS have welcomed this decision stating that it would effectively address the
inequality that the community faces in the healthcare sector.
The case study also reveals a clear breach of healthcare rights enjoyed by the patients.
These rights tell that the patients have the right to be treated kindly, with dignity and respect by
the healthcare staff working under NHS. The patients have the right to lodge complaints if they
feel that they did not receive services as they had expected. However, in case of the same-sex
couples, they did not receive what they had expected when they decided to consult the doctor of
their choice. As Evans (2013) notices, healthcare rights guarantee the rights and privileges of the
patients coming from different sexual backgrounds. However, the authors state, very few people
are aware about it. The authors highlight the need to be more aware aware about the healthcare
rights from both patients and healthcare professionals perspective is extremely important to
ensure that no patient is discriminated against. As it could be seen in the case study, the lesbian
couples were not aware of their healthcare rights and hence, they did not complain against Dr.
Roi or the NHS.

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The last issue identified is the lack of diversity recognition by the healthcare
professionals. Baillie and Matiti (2019) identified numerous instances where lesbian and bisexual
women were asked questions that clearly demonstrated the lack of recognition for diversity by
the healthcare professionals. One such example includes asking degrading and insulting
questions such as questions about contraception during cervical tests. The authors further found
that lesbian and bisexual women are not even considered as users of healthcares, which is a
concern because it challenges the claims of diversity boasted by nations. Parameshwaran et al.
(2017), find a lack of “specific LGBTQ healthcare education in medical school” result in
increasing neglect and bad behavior against them by healthcare professionals.
While these issues are morally incorrect, these are incorrect in terms of legal terms as
well. Several policies and legislations are there that consider these issues as illegal and even
punishable. The case study includes the lesbian couples and their child being denied care by the
doctor due to their sexual orientation. The doctor denied care because as she stated, it was
against her religious beliefs. However, as a healthcare professional, the doctor should have
provided care to the baby. As per the Health and Social Care Act 2008 (Regulated Activities)
regulations 2014: Regulation 9, every person using a service “have care or treatment that is
personalized specifically for them”. The regulation further states, “The action that providers must
take to make sure that each person receives appropriate person-centered care and treatment is
based on an assessment of their needs and preferences”. In view of this legislation, Dr. Roi must
have kept her religious beliefs aside and provided person-centered care for lesbian couple’s baby.
Another legislation or law that relates to this case is The Equality Act. The Act is a law
that provides protection to the people from discrimination. The Act applies to most forms of
discrimination including the discrimination based on sexual orientation. Public bodies such as

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hospital trusts, police authorities, and local authorities also come under the vicinity of this Act
and are referred to as Public Sector Equality Duty. Based on this Act, it could be stated that the
baby of the lesbian couples in the case study should have been given medical care. On October 1,
2010, the new Equality Act known as the Equality Act 2010 came into force that further protects
the rights of the individuals (Cqc.org.uk 2019). It is applicable to the case study because it also
includes the Equality Act (Sexual Orientation) Regulations 2007 as well. It needs mentioning
that the Equality Act 2010 was formed by merging nine major pieces of legislation that included
the Sex Discrimination Act as well. In one of the cases, Peter and Hazel Mary Bull v Stephen
Preddy and Martyn Hall 2011, the Supreme Court ruled in favor of the respondents because it
found direct discrimination by the appellants (Mr. and Mrs. Bull) based on sexual orientations as
Preddy and Hall were denied room in their hotel (Cqc.org.uk 2019). Although the case does not
involve healthcare setting but it provides a good view of the legislation provided to the lesbians
and other such people under the Equality Act 2010.
The doctor in the case study stated anti-gay religious beliefs as her reason for not
attending to the child of the lesbian couple. This shows that many religion in the world are there
that do not accept homosexuality as legal or even moral and hence pass religious laws that
prohibit or forbid people to practice it. As Gibbs and Goldbach (2015) state, religious laws have
often come in the way of the wellbeing of the LGBTQ community people because it is viewed as
against a specific religion. What this does is that it restricts the healthcare practitioners belonging
to specific religion to refrain from or refuse attending to LGBTQ patients or anyone related to
them. Nonetheless, it would be extremely unethical and wrong to state that a doctor or any
employer must not practice her or his religious beliefs at the workplace because they too have the
right to practice their beliefs. The European Court of Human Rights decision in the four cases

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brought about some changes in the legal rights related to religious beliefs in the workplace.
Previously, both the European Court and the domestic courts protected the religious practice of
the people under Article 9 “only if it was required by the particular religion or belief”
(Equalityhumanrights.com 2019). However, the new judgment states that any religious practice
that is sufficiently linked to the belief will be given protection whether or not it is mandatory to
the belief (Equalityhumanrights.com 2019. In that case, the religious belief practice by Dr. Roi is
protected under the new legal rights.
Conclusion and Recommendations
In light of the above discussion, it could be stated that the issues identified in the case
study are grave and must be addressed in order to make the healthcare services available to all
irrespective of sexual orientation. Some recommendations or solutions could be suggested to
ensure the accomplishment of the goals, which shall be discussed in the following sections.
At first, it could be recommended that the laws and acts determining the conduct of
healthcare professionals including doctors must be made stricter especially when it comes to
patients with different sexual orientation.
Further, it has to be made sure that the different legislations do not collide with one
another, which is evident in this case as the Equality Act 2010 collides with the Article 9 of the
European Convention on Human Rights integrated through the Human Rights Act 1998. While
the Equality Act 2010 gives enough rights to the receivers of services to raise their voice against
discrimination and inequality, Article 9 restricts that right as it empowers the service providers to
refuse or reject any provision based on their religious rights.

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The next solution based on the case study analysis that could be offered is that the NHS
England should clearly outline that the patients whose sexual orientation information would not
affect the course of the treatment need not reveal their sexual orientation. For example, in the
given study, the revelation of the sexual orientation of the couples led to the refusal of healthcare
to their baby by the doctor. The revelation was not required because it would not have made any
impact on the health outcomes.
To conclude, it must be stated that Dr. Roi although had the right to practice her religious
beliefs at the workplace, did take away the right from the lesbian parents to have their child
receive proper treatment and care. The paper analyzed the case study in detail and suggested
recommendations that could help in coping with such situations.

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References used:
Ageuk.org.uk 2019. What standards you should expect from NHS services | Age UK. [online]
Ageuk.org.uk. Available at:
https://www.ageuk.org.uk/information-advice/health-wellbeing/health-services/healthcare-rights/
[Accessed 2 Mar. 2019]. (Ageuk.org.uk, 2019)
Baillie, L. and Matiti, M. 2019. Dignity, equality and diversity: an exploration of how
discriminatory behaviour of healthcare workers affects patient dignity. [online]
Diversityhealthcare.imedpub.com. Available at: http://diversityhealthcare.imedpub.com/dignity-
equality-and-diversity-an-exploration-of-how-discriminatory-behaviour-of-healthcare-workers-
affects-patient-dignity.php?aid=1724 [Accessed 2 Mar. 2019]. (Baillie and Matiti, 2019)
Bbc.com 2019. Patients to be questioned about sexuality. [online] BBC News. Available at:
https://www.bbc.com/news/health-41625402 [Accessed 2 Mar. 2019]. (Bbc.com, 2019)
Dahl, B., Fylkesnes, A.M., Sørlie, V. and Malterud, K., 2013. Lesbian women's experiences with
healthcare providers in the birthing context: a meta-ethnography. Midwifery, 29(6), pp.674-681.
Dyer, K. and das Nair, R., 2013. Why don't healthcare professionals talk about sex? A systematic
review of recent qualitative studies conducted in the United Kingdom. The journal of sexual
medicine, 10(11), pp.2658-2670.
Equalityhumanrights.com 2019. Religion or Belief in the Workplace: An Explanation of Recent
European Court of Human Rights Judgments. [online] Equalityhumanrights.com. Available at:
https://www.equalityhumanrights.com/sites/default/files/gd.12.411-
1_religion_belief_workplace_judgments_26-03-14b.pdf [Accessed 2 Mar. 2019].

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Equalityhumanrights.com. 2019. Search | Equality and Human Rights Commission. [online]
Available at: https://www.equalityhumanrights.com/en/search?text=equality+act+
%28sexual+orientations%29+regulations+2007 [Accessed 2 Mar. 2019].
Evans, D.T., 2013. Promoting sexual health and wellbeing: the role of the nurse. Nursing
Standard, 28(10).
Gibbs, J.J. and Goldbach, J., 2015. Religious conflict, sexual identity, and suicidal behaviors
among LGBT young adults. Archives of suicide research, 19(4), pp.472-488.
Gmc-uk.org 2019. Personal beliefs and medical practice. [online] Gmc-uk.org. Available at:
https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/personal-beliefs-and-
medical-practice [Accessed 2 Mar. 2019]. (Gmc-uk.org, 2019)
Hayman, B., Wilkes, L., Halcomb, E. and Jackson, D., 2013. Marginalised mothers: Lesbian
women negotiating heteronormative healthcare services. Contemporary Nurse, 44(1), pp.120-
127.
Parameshwaran, V., Cockbain, B.C., Hillyard, M. and Price, J.R., 2017. Is the lack of specific
lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ) health care education in
medical school a cause for concern? Evidence from a survey of knowledge and practice among
UK medical students. Journal of homosexuality, 64(3), pp.367-381.