Most people assume that doctors, with all their years of medical training, are superheroes in white coats on a mission to save everyone in any circumstance! And there is a degree of truth in this. Most people enter the healthcare profession out of a strong personal desire to help others.
But is it ever ok for a doctor to refuse to treat a patient?
While there is a lengthy moral debate here, there are also potential legal ramifications if a medical professional refuses to treat a patient in some circumstances.
In private practice
The Health Care Complaints Commission in New South Wales does receive occasional complaints from people when they don’t get an appointment with a medical professional. People assume they have the right to be seen by a doctor when they ask.
In private practice, medical staff are free to choose how to run their business. This means they can choose who they see as patients, as well as the operating hours of the practice.
If the patent’s situation is not considered to be an emergency, then the doctor may refuse to see the patient for a number of reasons, perhaps they don’t have an available appointment, or they believe that taking on a new patient would compromise the care that they can provide to their existing patients.
Ending a patient / doctor relationship
Sometimes, a medical professional may also choose to end his/her relationship with a patient, and refer them to another suitable practitioner. This may be because the doctor feels that he is unable to help the patient further, because perhaps the patient’s needs are outside his/her realm of professional expertise.
A doctor can also choose to end a patient relationship if he feels like it has broken down, and communication is not working. Other cases may include circumstances that may dictate a breach of personal boundaries, or give rise to a conflict of interest, for example if the patient is a friend or family member, or a business associate where there is a vested financial interest.
A doctor does not have to act contrary to their own beliefs but they do have an obligation to accept the patient’s beliefs, and not to impose their own beliefs onto their patients.
No situation is ever ‘black and white'.
What if, for example, you have a patient who is mentally ill and who is disruptive at the clinic, unsettling to other patients or an impediment for front desk staff? Do you have a right to refuse treatment? Or do you need to make arrangements to treat the patient at their own home or another facility? Or at a time when there are no other patients in the waiting room?
These are real issues for doctors and they shouldn’t be taken lightly.
But if the decision is made to end the patient relationship, it is important to ensure that the patient has access to ongoing care by another medical professional by way of referral and the transfer of patient information.
It’s important to remember that a doctor cannot discriminate and refuse to see a patient on the basis of religion or race or gender etc. It’s also important to know your patient’s rights.
Duty of care
According to the Royal Australian College of GPs, which explores this subject in detail on its website, “the common law (case-based law) surrounding a doctor’s interaction with a patient within the confines of a standard doctor–patient relationship is relatively settled; doctors have a legal obligation to patients to adhere to a standard of reasonable care. This duty of care exists between doctors and patients both ethically and with respect to common law and legislation. The definition of a ‘patient’ is interpreted broadly; a duty of care may exist between doctors and future patients, and even between medical administrators and hospital patients.”
Refusal to assist in emergency
In an emergency situation, most medical professionals may be willing to help regardless of whether they have a relationship with the patient or not, particularly if the patient is at risk of imminent harm.
However, when a medical practitioner does not have a pre-existing relationship with a patient within a standard clinical context and is called upon to assist in an emergency and treat a stranger, can treatment be refused?
Ethical issues aside, there are also potential legal issues here. It is an incredibly complex area.
If a doctor refuses to help and, for example, denies being a medical practitioner, or does not voluntarily assist in the situation, this could be considered an act of professional misconduct or even negligence. However, of course, due consideration must also be given to a doctor’s particular professional expertise, and therefore knowledge, skills and ability to assist in the particular situation.
Code of Conduct for Doctors In Australia
The Code of Conduct for Doctors in Australia, which is published by the Medical Board, is designed to be considered by courts, boards, councils and tribunals to assess professional standards by which medical practitioners will be judged in all circumstances.
The code indicates that good medical practice involves offering assistance in an emergency that takes account of the clinician’s safety, skills and the availability of other options.
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