Ethics: Denying patient care

[Apoplexy__]

I was under the impression that in order to dispute the legality of a physician denying care, you would have to consider the consistency of who does and doesn't get denied. For example, selectively discriminating the patients you accept based on age, race, religion, HIV status, etc. is obviously illegal and unethical.

But I just got the following question: PCP refers stable patient to cardiologist, and after short lobby wait, patient is denied. Answer: Neither PCP nor cardiologist are at ethical fault. ...No other information given.

How could you determine that this denial is legal or not without more information? Can physicians just at any time decide that they feel they cannot take in another patient?

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[Myxedema]

Doctor-patient relationship is a voluntary one. Just as a patient may reject a doctor and can't be compelled to submit; a doctor can't be forced to accept a particular patient as well. There is no legal obligation for doctors to accept any patient - you may choose, as a doctor, to have no patients at all. What you can't do as a physician, however, is to abruptly terminate the doctor-patient relationship once you've accepted a patient.

 

[Apoplexy__]

Doctor-patient relationship is a voluntary one. Just as a patient may reject a doctor and can't be compelled to submit; a doctor can't be forced to accept a particular patient as well. There is no legal obligation for doctors to accept any patient - you may choose, as a doctor, to have no patients at all. What you can't do as a physician, however, is to abruptly terminate the doctor-patient relationship once you've accepted a patient.

I thought that in addition to being legally able to accept either all or no patients, you were legally obligated to NOT take SOME patients. In other words, when Bob and Joe come in your office, you can't see Bob then deny Joe. Was I just supposed to assume that the doctor that didn't take this one patient in the question stem was not taking any patients at all?

 

[swoopyswoop]

I thought doctors COULD terminate patient relationships. I also think you can choose to not accept one patient but take another. Does anyone have a source on the actual rules?

 

[NeuroLAX]

I thought doctors COULD terminate patient relationships. I also think you can choose to not accept one patient but take another. Does anyone have a source on the actual rules?

Overall I believe that you cannot terminate once you've accepted the responsibility of taking care of a patient unless there is a really good reason. I think Kaplan gives a few examples of instances where you can terminate relationship, like for offensive behavior or lack of payment. I don't know if these have been agreed upon by everyone but I would also be interested in verifying these statements with a more authoritative source.

 

[Myxedema]

I thought that in addition to being legally able to accept either all or no patients, you were legally obligated to NOT take SOME patients. In other words, when Bob and Joe come in your office, you can't see Bob then deny Joe. Was I just supposed to assume that the doctor that didn't take this one patient in the question stem was not taking any patients at all?

There is no legal obligation to see Joe after seeing Bob. Even if they come together, even if Joe thinks his condition must take precedence, you can see Bob and deny Joe. Nobody can force a doctor and a patient into entering a doctor-patient relationship.

Overall I believe that you cannot terminate once you've accepted the responsibility of taking care of a patient unless there is a really good reason. I think Kaplan gives a few examples of instances where you can terminate relationship, like for offensive behavior or lack of payment. I don't know if these have been agreed upon by everyone but I would also be interested in verifying these statements with a more authoritative source.

I've looked back at the Kaplan Medical Ethics book after you've mentioned this (I highly recommend this book by the way). It says: "Once a patient and physician have entered into a care relationship, there is far greater complexity in ending that relationship. A physician cannot suddenly end relationship. He must maintain the care of the patient until the patient can find appropriate alternate source of care and he must give 'reasonable notice'." (Chapter 12, p. 62, for those who wish to refer to that book)

 

[Apoplexy__]

There is no legal obligation to see Joe after seeing Bob. Even if they come together, even if Joe thinks his condition must take precedence, you can see Bob and deny Joe. Nobody can force a doctor and a patient into entering a doctor-patient relationship.

Ah, thanks. A quick review of Kaplan's video series says what you said, then also mentioned that you can't discriminate based on race, age, etc. The take-home point is that unless they make it obvious that you're discriminating by doing so, you can always deny a patient.