Medical Practice and its Legal obligations

Medical Profession - Ethics and Legality in India

Query. Can a Medical Practitioner legally de-associate himself or refrain from treating a patient?

Ø  There are only a few or limited grounds on which medical professionals can refuse treatment to a patient. One is when the patient refuses to follow the treatment advised by the doctor.  Another is when a patient already under the care of one doctor approaches another for treatment. Such patients cannot be accepted unless they are referred by their first doctor, or they leave the care of the first doctor. Finally, a patient whose treatment is beyond the expertise of the doctor can be directed to an expert. Let us now discuss in detail.

INDIAN MEDICAL COUNCIL (PROFESSIONAL CONDUCT, ETIQUETTE AND ETHICS) REGULATIONS, 2002, provide as follows:

Regulation 2. DUTIES OF PHYSICIANS TO THEIR PATIENTS

Obligations to the Sick

2.1.1 Though a physician is not bound to treat each and every person asking his services, he should not only be ever ready to respond to the calls of the sick and the injured, but should be mindful of the high character of his mission and the responsibility he discharges in the course of his professional duties. In his treatment, he should never forget that the health and the lives of those entrusted to his care depend on his skill and attention. A physician should endeavour to add to the comfort of the sick by making his visits at the hour indicated to the patients. A physician advising a patient to seek service of another physician is acceptable, however, in case of emergency a physician must treat the patient. No physician shall arbitrarily refuse treatment to a patient. However for good reason, when a patient is suffering from an ailment which is not within the range of experience of the treating physician, the physician may refuse treatment and refer the patient to another physician.

2.1.2 Medical practitioner having any incapacity detrimental to the patient or which can affect his performance vis-à-vis the patient is not permitted to practice his profession.

The Patient must not be neglected

Again, as per Regulation 2.4: A physician is free to choose whom he will serve. He should, however, respond to any request for his assistance in an emergency. Once having undertaken a case, the physician should not neglect the patient, nor should he withdraw from the case without giving adequate notice to the patient and his family. Provisionally or fully registered medical practitioner shall not willfully commit an act of negligence that may deprive his patient or patients from necessary medical care.

However in case of serious illness and in doubtful or difficult conditions, the physician should request consultation, but under any circumstances such consultation should be justifiable and in the interest of the patient only and not for any other consideration.

In every consultation, the benefit to the patient is of foremost importance. All physicians engaged in the case should be frank with the patient and his attendants.

Patients Referred to Specialists

Regulation 3.6 : When a patient is referred to a specialist by the attending physician, a case summary of the patient should be given to the specialist, who should communicate his opinion in writing to the attending physician.

In the matter of medical referral, there is also another ethical consideration with medico- legal significance. It is the question of primary responsibility. This depends on the nature of the referral. If for instance, it is a consultation between general practitioner and specialist, the latter is mainly responsible for the continued care and concern for his patient. The general practitioner merely follows the advice of the consultant, reporting to him the progress of the patient so as to modify therapy or obtain further instructions with regard to continued care.

Act not intended to cause death, done by consent in good faith for person's benefit

As per Section 88 of the Indian Penal Code 1860:

Nothing which is not intended to cause death, is an offence by reason of any harm which it may cause, or be intended by the doer to cause, or be known by the doer to be likely to cause, to any person for whose benefit it is done in good faith, and who has given a consent, whether express or implied, to suffer that harm, or to take the risk of that harm.

Illustration

A, a surgeon, knowing that a particular operation is likely to cause the death of Z, who suffers under a painful complaint, but not intending to cause Z's death, and intending in good faith, Z's benefit performs that operation on Z, with Z's consent. A has committed no offence.

Scope

Consent is good defence to all offences in general. But if once it is proved in a case of rape that the girl in question was below 16 years, her consent becomes wholly irrelevant and the accused is liable for the offence as if no consent were obtained; Harpal Singh v. State of Himachal Pradesh, AIR 1981 SC 361.

Here it would also be expedient to refer the Law Commission of India (196^th Report) on ‘Medical Treatment to Terminally ill Patients (Protection of Patients and Medical Practitioners)’

Every medical practitioner who takes a decision to withhold or withdraw medical treatment must maintain a register giving details as to why he is or is not satisfied that a patient is competent and as to why he considers the patient has or has not taken an informed decision, as to the opinion of the experts from the panel; the age, sex, address of the patient and what is in the best interests of the patient and other particulars. The information will have to be kept confidential.

·         The medical practitioner has to inform the patient (if he is conscious) or parents or relatives about his decision to withhold or withdraw treatment and if they desire to move the High Court, he has to wait for 15 days and if no orders are received from the High Court, he can proceed.

·         A copy of the contents of the register relating to each such patient shall be lodged, as a matter of information, with the Director General of Health Services or Director of Medical Sciences, as the case may be, immediately on the taking of a decision to withhold or withdraw treatment and an acknowledgement therefore will have to be obtained. The above authorities will also have to keep the information confidential.

Conclusion : Being a professional in his own right, the doctor/ Medical Practitioner certainly has an ethical right to refuse to treat a patient, who will, in his view, not follow treatment directions to their logical ends. This right not to treat or accept for treatment also extends to those situations where a patient approaches a doctor insisting on a predetermined mode or line of treatment and to some other situations mentioned above. But all such actions must conform to the moral, ethical and legal values.