Case and Commentary
Jan 2005
Physicians are professionals who have obligations to use their skill and knowledge for the benefit of society. Although physicians retain a great degree of control over their practice, they often must subjugate their self-interest to the interests of patients. Physicians may not always have the prerogative of choosing whom to serve. Professional responsibilities to provide care, the need for patients to receive care, and the responsibility to act in the best interest of patients, all place limits on physicians' prerogative to select their patients.
Giving physicians some choice in "whom they serve" arises from the notion that the patient-physician relationship is generally one of "mutual consent." There are two bases for physicians' prerogative to choose whom to treat. The first is a general privilege held by all members of society that accords them a right to choose with whom to associate. Physicians do not give up their freedom of association merely by becoming professionals. But they do assume certain obligations that place limits on their choices in the context of serving patients.
The second aspect of the physicians' prerogative stems from the notion of professionalism. Physicians are granted considerable autonomy within the context of the patient-physician relationship, and this autonomy includes the freedom to choose whether to undertake the treatment of a particular patient. However, this autonomy is not designed to further physicians' self-interests and is not without qualifications. The Code balances individual choice with the greater concern of providing access to care, greater responsibility in emergency situations, and continuity of care. In Opinion 10.05, "Potential Patients," the Code provides clear guidance about when it is unethical to refuse a patient, as well as when such refusals are justifiable. It states:
The following instances identify the limits on physicians' prerogative [to refuse patients]:
a) Physicians should respond to the best of their ability in cases of medical emergency...
b) Physicians cannot refuse to care for patients based on race, gender, sexual orientation, or any other criteria that would constitute invidious discrimination...
c) Physicians may not refuse to care for patients when operating under a contractual arrangement that requires them to treat...
In situations not covered above, it may be ethically permissible for physicians to decline a potential patient when:
a) The treatment request is beyond the physician's current competence.
b) The treatment request is known to be scientifically invalid...
c) A specific treatment sought by an individual is incompatible with the physician's personal, religious or moral beliefs."
Generally physicians have greater latitude in refusing potential patients when the refusal occurs prior to the establishment, or the appearance of an establishment, of a patient-physician relationship. Once a professional relationship has been initiated, it is clearly unacceptable to neglect the care of a patient.
