Khamis, 7 Februari 2008

Can Doctors Refuse to Treat???

“…I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery…. Above all, I must not play at God…”

- phrases taken from the modern version of the Hippocratic Oath.

There are millions of medical students throughout the world today pledged by the modern version of the original Hippocratic Oath upon their graduation. Historians believe that the original Hippocratic Oath was written by Hippocrates, Greek’s farther of medicine way back in the 4th century BC. It is an oath traditionally taken by physicians pertaining to the ethical practice of medicine. As centuries pass, the modern version of the oath was penned by Dr. Louis Lasagna, former Dean of the Sackler School of Graduate Biomedical Sciences of Tufts University in 1974. Since then, the above modern oath has been the ethical guide for almost all medical practitioners.

Doctor by definition is a person licensed to practice medicine, as a physician, surgeon, dentist or even veterinarian. It is a profession that generally known by the public as those who provide care and treatment for those in need regardless of the individual background or condition. With the increasing demand from the public for better healthcare nowadays have once again raised the question whether can doctors refuse to treat. The answer is straight and simple backed by the Oath itself – Yes, but under certain circumstances and condition.

Doctor has the right to decline treatment to patients under certain conditions such as; the availability of the doctor himself whether his fit and healthy to carry out his job. Doctor may refuse to give treatment to a patient if he has had a bad experience while providing the same treatment to a patient in the past. Doctor cannot be compelled to treat a patient in odd hours. That is at hours other than those ear-marked by him for his profession. There is no legal obligation to answer a call to visit the patient at his or her place of residence. Doctor must treat a patient in emergency situation on ethical grounds however 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. In other condition, if a patient does not agree with the method of treatment, doctors may refuse to treat the patient. 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 skills, facilities, instruments, medicines, or staff, he may refer the patient to appropriate destination.

There are many interesting examples when doctors refuse to treat occurred in many parts of the world due to vast amount of reasons. In 1987, Dr. John Bower, a kidney specialist at the University of Mississippi Medical Center, was sued after dismissing from his practice a patient who regularly missed dialysis appointments, verbally abused nurses and even threatened to kill Bower and a hospital administrator. Bower cited medical noncompliance and violent threats as grounds for terminating care. The Fifth Circuit Court of Appeals, in New Orleans, agreed with him, ruling that doctors can refuse to treat violent or intransigent patients as long as they give proper notice so that the patient can find alternative care. Forcing doctors to treat such patients, the court said, would violate the 13th Amendment of American Law, which prohibits involuntary servitude.

It is the same case here in Malaysia’s public hospitals or medical facilities, due to long hours of waiting and little time spend by doctors for each patient have somehow cause tension between the client and the service provider. Once a while, as tension mounts, patient tends to become abusive towards doctors by yelling and screaming or even worse by threatening doctors and medical staffs. This would put doctors in a difficult position and no longer in the position to treat such patient. The duty of care then is to pass on the patient to another colleague either in the same hospital or another hospital.

In rare cases, doctors have objected to treatment on moral grounds. In February 2001, it was reported that surgeons in Melbourne, Australia, were refusing to provide heart and lung transplants, coronary-bypass surgery and lung-reduction surgery to smokers. At one hospital, surgeons insisted that patients be free of nicotine, alcohol and other drugs for at least six months before going into the operating room. ''Why should taxpayers pay for it?'' one surgeon asked. ''It is consuming resources for someone who is contributing to their own demise.'' The policy predictably drew an outcry from human rights organizations and many doctors. The Australian Medical Association said it was ''unconscionable'' for a surgeon to take a moral stand on treating a patient. Ethicists said it was discriminatory because lifestyle could be blamed for many illnesses, including obesity and certain types of cancer. This is the issue of discrimination and best to be avoided by doctors since they must not apply their values to the patient’s values. Doctors must not refuse to treat patient on this basis since it is not the doctors’ right to judge patient. Above all doctors must not play God in providing treatment to patients.

Doctors are also normal human being that has feelings, needs and expectations. However above of all, once a doctor pledged with the Oath, there are enormous amount of responsibilities that a doctor must uphold. It is important for doctors to their best medical judgment and knowledge able to decide whether to treat or not when patients come for care. A phrase that I always remembers as quoted from Prof Emiritus Datuk Dr Alex Delilkan is;

“We do what we do to the best of our ability for which we think in the best interest of the patient at that very moment of time”.

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