The view I take in regards to human dignity is that from the patient. "Do no harm" is proof that the patient comes first. That means that the patient has the right to "self-determination" and ultimately the right to say "NO."
The physician needs to be free of any external influences to make decisions that are in the best interest of the patient. Ultimately, the physician and the patient need to determine the course of treatment, openly and freely, without coercion or external influences.
That means that the physician myst be free of external, 3rd party influences. So who are these 3rd parties that influence physicians?
Insurance companies, corporations that own hospitals, quotas and policies set by these corporations, provider networks, other departments in the hospital, the employers of the physician. If a hospital has a policy that a physician feels will harm the patient, the physician myst adhere to that policy and potentially harm the patient OR be unable to treat the patient, thus harming the patient.
The physician must also be free from repercussions of that decision. That is not to say that the physician is not accountable. The physician may have to explain his decision making. In being accountable to a 3rd party should be treated similar to a patient's right to refuse treatment: as long as the physician has capacity, the decision must based on logic.
For example if a corporate hospital system has a quota for physicians to refer to radiology, a physician may logically forego radiology with a certain condition where the physician has diagnosed the problem and radiology is not necessary. If the physician misses his quota, then he should not be sanctioned if he can show that all his cases from that month did not need radiology by his logic.
This places the care in the hands of the physician to be tempered, guided, and ultimately decided by the patient. I have no problem in absolving the doctor from liability when the patient directs care, but only so far as reasonable. OPTIONS must be part of the decision making.
A physician can't say the prostate cancer patient is refusing ALL surgery, so I didn't bother telling him that his appendix burst. A physician also can't say "this is the best way, so it is the only way (or else no way)" OR "this is my preferred way (or else no way)."
Thank you for reading.