Refusing a Patient

Emergency cases and medical Ethics

Medical practitioners form a privileged section in the society, which carries with it the onerous responsibility of responding to the most basic need of human beings – health. The right to health and treatment has been universally acknowledged as one of the primary components of the right to life. The role of doctors in ensuring this right is integral. At the same time, sight must not be lost of the fact that doctors too, are professionals. All professionals, in general, for instance an accountant or a fashion designer, have the option to refuse any client. However, in light of the significance of the right to treatment of patients, the exercise of the right to refuse a patient by a doctor is, to some extent, curtailed. This post seeks to draw the balance between the right to treatment of patients, and the rights and obligations of doctors as a class of professionals.

Unfortunately, it is a common practice for doctors and hospitals to refuse treatment to patients. While there can be many valid grounds on part of doctors to refuse treatment, the stark ground reality remains that helpless patients in need of urgent medical attention is sent running from pillar to post, without the necessary and timely treatment. Moreover, the prohibitively exorbitant private medical treatment is beyond the affordability of a vast section of the population. How then can the right to medical treatment be made effective, given the scarcity of economic resources and infrastructure and issues of affordability of medical treatment

The Legal Framework:

Within the legal framework, the right to emergency medical care has been accepted by both the international community as well as the Supreme Court of India as a fundamental right. The ground reality, however, is far from desirable. This has been discussed in greater detail in another post, here. <Link to post>

Besides this, statutes in India dealing with doctor’s duty to treat are:

1. Code of Ethics Regulations, 2002 – Under the Code of Medical Ethics Regulations, 2002 the doctor has an obligation to treat an emergency patient.

2. Indian Medical Council Act, 1956

Medical Malpractice, Refusal of Service

Professional Rights and Responsibilities:

Bearing in mind the social expectations as a doctor, he must exercise his professional rights and obligations responsibly. Under no circumstance, should he exercise his discretion in providing medical treatment unreasonably, irresponsibly or arbitrarily. Religion, nationality, race, party politics, social standing etc. cannot be a ground of refusing treatment to a patient. This profession is considered to be a service to the humanity – accordingly, a doctor can refuse to treat a patient only on justified grounds.

Of course, an unreasonably onerous burden of responsibility cannot and should not be placed on doctors, especially given the lack of resources and limited infrastructure. For instance, if even after reasonable and ordinary clinic timings, there is a queue of patients, he may refuse to provide them a consultation on that day. However, he is not entitled to refuse treatment to a patient requiring emergency medical care, as codified under the Code of Medical Ethics Regulations, 2002.

Some situations when a doctor can refuse to give treatment are:

    1. If the doctor does not have adequate skill or means to treat the patient

    2. If referring the patient to another medical practitioner is beneficial for the patient; for example, if the doctor does not have the time or the expertise to attend to the needs of the patient

    3. If the doctor does not have the adequate facilities or equipments necessary for the treatment of the patient.

Furthermore, once a doctor chooses to serve a patient he has to take utmost care of him, and the responsibilities of doctors extend even in the event of withdrawal of medical treatment. A doctor can withdraw from a case only after having given proper notice to the patient based on good reasons, ensuring that the patient is in no way adversely affected or prejudiced by the withdrawal of treatment. A doctor cannot deny treatment to an existing patient arbitrarily and cannot deprive a patient from necessary medical care as it will amount to medical negligence which is subject to disciplinary action by the Medical Council of India and State Councils.

Implementation and enforcement:

The Medical Council of India is the statutory body responsible for regulating the standards in the practice of medicine. If any complaint with regard to professional misconduct is brought before a state or national medical council for a disciplinary action an enquiry will be held on such misconduct and also the party will be given an opportunity to be heard. If he is found to be guilty of professional misconduct, the Council may suspend the license to practice for a period of time by removing his name from the register. The Council can also permanently restrain a doctor from practicing in India. In case of removal of name for a limited period of time the council may direct to restore the name in the register in expiration of the suspension period. Before reaching the final decision, the council may restrain the doctor or physician from performing the procedure or practice which is under scrutiny.

At the end of the day, a fine balance has to be drawn between the professional right of discretion of doctors regarding which patients he chooses to treat, and the obligations that a doctor owes to individuals in need of treatment and the public at large. Particularly in the Indian context, affordable medical care and effective treatment by doctors also requires addressing larger social issues or resources and roles and responsibilities of doctors vis-a-vis patients.

About Sanghita

Pursuing B.A. LL.B., Mass Communication, Security laws(Hons.) at National Law University Orissa.
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  • Sujal

    My dad suffered from heart attack in April. We went to a doctor(cardiologist) who referred us to a pvt. hospital. Angeography cudnt be done bec of high creatinine levels in blood. he was discharged. The cardiologist who had referred us to that hospital started dad’s treatment by oral medication. Every month we got his blood test done at a particular lab. he showed improvements in all blood tests. but the creatine level remained around 3. the doc in this month asked us to get blood test done from the lab which he usually recommends to his patients. Prima facie the lab wasn;t gud nor the technician was MD. but we gave blood samples. he gave normal report. creatinine was 0.9. we doubted his report and got tested again from the lab from whr we get the test done regularly. the creatinine level there was 3. we showed both reports to doc. he got angry bec we doubted the lab whr he had sent us. since 4 months the doc is giving medicine for heart and not for kidney( creatinine) and so it dramatically reducing to normal level is unbelievable bec two leading nephrologist of the town said that creatine wont come down to normal from 3. when i stated the same to the cardiologist he got angry and asked us not to enter his clinic again. After 4 months of treatment, still when dad isnt recovered fully, can the doc abruptly refuse to treat bec his ego is hurt? can i take a legal course of action against the doc and the lab which gave fake reports?