Can a doctor refuse to treat a patient?

Dr Devendra Gupta

In this present era of scientific development and increasing awareness regarding rights and duties of individuals throughout the world, debates are organised concerning human rights with special reference to rights of the accused, rights of the victims, rights of the women, rights of the children, rights of prisoners and so on. With consumer cases against doctors on the rise, it is time to emphasize that medical professionals who perform their duties with devotion and sincerity too have their rights. So what are his rights?

Rright to decline treatment?
Does a doctor has the right to decline treatment to patients.If yes, then under what conditions:

a) If the doctor himself is not well or free.
b) Doctor may refuse to give fresh treatment to a patient if he has had a bad experience in the past.
c) He cannot be compelled to treat a patient in odd hours. That is at hours other than those ear-marked by him for his profession.
d) There is no legal obligation to answer a call to visit the patient at his or her place of residence.
e) Doctor treats a patient in emergency on ethical grounds.. It does not mean that he has accepted the patient. He may advise that patient to go to some hospital or a specialist for further treatment.
f) If a patient does not agree with the method of treatment or fee asked, doctor may refuse to treat the patient.
g) In his honest opinion, if a doctor feels that he is not in a position to treat a patient because of non availability of certain facilities, instruments, medicines, staff etc. he may refer the patient to a suitable place.

Selection of drugs
In some diseases, more than one medicines are effective and the decisions as to which of them should be prescribed is the absolute right of the doctor. Here doctor applies his own knowledge, experience and skill, over and above giving consideration to theoretical effects of the medicine.

Selection of method
In medical science, more than one type of treatment are approved and available for a particular disease. A doctor may adopt any one of them. For example, the removal of gall bladder (cholecystectomy) can be performed through various incision, with the choice of incision depending on the doctor based on his experience. Moreover, in a surgery, from anesthesia to stitch thread, everything is to be decided by the surgeon only.

Investigation
It is not always possible for a doctor to make certain diagnosis only from clinical examination of the patient. Additional laboratory tests, X-ray, sonography etc., may be required. The doctor is the best judge to decide about number and type of investigations to be carried out.

Some doctors insist for a particular laboratory or X-ray clinic as in his opinion their reports are perfect and reliable. Of course patient might take it the other way, so a doctor may insist but should not over insist. In emergencies, the doctor has wider discretion about the treatment.

Medico-legal case
A doctor has a right to take any medical case without hesitation. At the same time, as a duty bound citizen, he is supposed to inform the police about such case as early as possible.

In the case of “Parmanand Katara” and the Union of India (1989 Supreme Court P.2039), the Supreme Court has said, “Doctors should boldly and bravely assert their ethical and legal duties and their right to carry on their profession which is their fundamental right as recognised by Article 19 of the Constitution of India. Further we are of the view that every doctor wherever he is within the territory of India should forthwith be aware of this position and therefore, we direct that this decision of ours shall be published in all journals reporting decisions of this court and adequate publicity highlighting these aspects should be given by the national media as also through the Doordarshan and the All India Radio.”

Visit
The doctor is not bound to honour every visit call, especially at odd hours. It is expected that a doctor would visit a patient, who is under his treatment and whose condition is worsening. In this sensitive matter, a doctor should take decision according to time, place and circumstances.

Medical Record
As a patient’s medical report is prepared by the doctor on his own stationary, it becomes doctor’s property. Doctor may not disclose it to the patient. If, in his opinion, the disclosure is not in patient’s benefit, he may, on the other hand, disclose the record as a whole or part of it in public interest under some statute.

Fees
The doctor has a right to recover his fees from the patient, whom he has given treatment.

Often the patient refuses to pay fees after completion of treatment and the doctor, just to recover the fees, does not discharge the patient or tries to keep some valuable property of the patient in his possession. This is a crime. The only way to recover the fees is a civil suite.

To avoid this problem, doctor should explain to the patient about approximate expenses of the treatment and may take part of it in advance and remaining in installments.

Right to delegates power
A patient may be under the treatment of a doctor, but both treatment and care is not a one man show. A doctor may need help of other doctors, nurses, technicians and other qualified staff. So the doctor has to delegate some power to other qualified persons and it doesn’t mean negligence.

To end, medical professsion is a very respectable profession. Doctors are looked upon by common man as their only hope when a person is hanging between life and death. So in such circumstances, doctors rights should be safeguarded. To have rights, doctors should also peform their professional duties with utmost sincerity and devotion upholding medical ethics.

(The author is administrator, Shanti Mangalick Hospital, Agra)