Observations Heads Up

Choosing who to treat

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h5828 (Published 03 November 2015) Cite this as: BMJ 2015;351:h5828
  1. Krishna Chinthapalli, neurology advanced trainee
  1. 1Royal North Shore Hospital, Sydney, Australia
  1. kchinthapalli{at}bmj.com

When might it be justifiable to refuse to treat a patient?

“Physicians are not bound to treat everybody who walks through their door,” except in emergencies, argued a US surgeon in 2004.1 He had proposed a resolution to the American Medical Association that doctors refuse treatment to medical malpractice lawyers in response to frustration at mounting malpractice insurance bills. Of course, the measure was denounced, with one wit responding, “What [he] is proposing is egregious, both hypocritically and Hippocratically.”

But are there circumstances in which refusal to treat (apart from emergencies) is justified if alternative care is available? One accepted scenario is refusal to see new patients if a practice is already full. The American Medical Association’s guidelines state that treatment can also be refused if it is beyond the physician’s competence or if it is “scientifically invalid.”2 Physical violence and danger to self may also be valid reasons, at least legally. In 1987 a precedent was set when a US doctor successfully used the 13th Amendment (the one abolishing slavery and involuntary servitude) to argue that he should not be forced to treat an abusive …

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