Topics : Duty to Treat

Choice in Healthcare Relationships
Physician Duty to Treat
Good Samaritan Laws
Case for Discussion : Duty to Patients who cannot Pay

Choice in Healthcare Relationships

One of the key principles of medical ethics in the United States is that physicians should be free to treat patients of their own choosing and vice versa. The key justification for this approach is that all patients and physicians will be better served if they enter into voluntary relationships. In a sense, physicians are free to choose the patients they wish to treat. For example, if a physician wishes to limit his practice to the care of children, he is free to do so.

There are, however, limitations on freedom to choose patients. Sometimes, the terms of employment may limit a physician’s ability to pick and choose patients. Hospitals, for example, can ill afford to have physicians declining to treat patients whom they admit. The courts have held, too, that emergency rooms must treat all patients who are in need of immediate and life-sustaining treatment. Medical students are not usually free, either, to decide whom they will treat or not treat. It is important to medical education that students be exposed to a broad range of disease and a broad range of patients. Certainly, the involvement of students in treatment of patients with communicable diseases should be guided by keeping their exposure limited according to their skill levels. In other words, students should not begin practicing blood draws on patients with HIV infection. As students become more skilled in drawing blood, the students should be able to draw blood from a patient infected with HIV.

Even as it allows choice in health care relationships, the medical profession does not want, either, to orphan patients with communicable diseases from treatment. (See “Communicable Diseases.”)

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Physician Duty to Treat

A physician assumes a duty to treat a particular person when he or she agrees to do so or is expected to do so as a condition of employment. For example, if a mother brings her child to see a physician in private practice, the physician assumes responsibilities toward that child by seeing the child, conducting a history, physical examination, and so on. If that same mother takes her very sick child to a hospital, the physicians in the emergency department assume the responsibility to care for that child as a patient until such time as any life-threatening condition is brought under control or the child is transferred to other appropriate care.

Both physicians and healthcare institutions can bring relationships – and their duties – to an end. Suppose a patient consistently fails to appear for appointments, fails to comply with recommended treatment, and fails to pay the physician. Under these circumstances, a physician can provide advance notice to the patient that he or she will not longer see and treat the patient. Patients can also be turned away for being unable to pay if physicians make efforts to ensure that the patient is not abandoned with regard to needed critical care. Healthcare institutions can take similar steps. In both cases, however, patients may not be abandoned at times of critical need.

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Good Samaritan Law

Many states try to encourage the voluntary participation of physicians at accident sites. Some physicians chose not to treat accident victims because of fear that they would be open to charges of malpractice. Like other states, Illinois now gives physicians substantial protection from charges of substandard medical treatment. This protection takes the form of a statute that provides that licensed physicians who stop treat emergency victims -- on public roads, public establishments, etc. -- shall not be liable for civil damages unless there is willful or wanton misconduct involved. In other words, if a physician stops to treat an accident victim but is limited in what he or she can do because of the absence of equipment or medication, the accident victim cannot then turn around and charge the physician with malpractice. This law is generally credited with encouraging physicians to treat accident victims at the scene without worries about malpractice.

Case for Discussion : Duty to Patients who cannot Pay

Jack Armstrong is an orthopedic surgeon who formerly worked at a local community hospital in his suburb. He left that arrangement one month ago in order to join a sports medicine clinic.

One Sunday morning at 3:25 am, he receives a call at home morning. The caller from the emergency room staff did not realize that he had left the hospital and was calling about a 23-year-old student from a local college who had fallen off the deck at a pool party. The young man had suffered serious damage to his foot, and no one was available at the hospital at that time to evaluate him.

The student had arrived at the emergency room awake but intoxicated and slightly incoherent. When asked, the young man does manage to say that he has no insurance.

Study Questions

1. Is Dr. Armstrong under any obligation to treat the injured young man in this case?
2. The young man in this case faces potentially serious damage to his foot. If Dr. Armstrong does not evaluate the case, has he lapsed in any professional responsibility?
3. Would Dr. Armstrong be justified in avoiding this case simply because the patient had no insurance?

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