‘no hospital or medical practitioner shall refuse to provide emergency medical care to victims of accidents or those in emergency medical condition on the ground that it is a medico-legal case or that the person is not able to pay or that he has no reimbursement facilities. If they refuse treatment that will be an offence’. This is the legal position but is riddled with many flaws. While a patient can reject a doctor or his advice at any stage, doctors do not have such freedom. It is the duty of the registered medical practitioner to attend the injured and render medical aid, treatment without waiting for procedural formalities unless the injured person or guardian desires otherwise. The effort to save the person and preserve the life should be the top priority. The professional obligation of protecting life extends to every doctor, whether at Government hospital or otherwise. The obligation being total, absolute and paramount, no statutory or procedural formalities can interfere in discharging this duty. Non-compliance of these directives may invite prosecution. If an FIR is lodged from the side of the patient’s family, a doctor can readily be arrested for not complying with the above guidelines. What if the doctor is not feeling well or does not know the required treatment or is leading a retired life well past 65 years of age?

 

A few days back a patient visited doctor’s clinic with high-grade fever and vomiting, for that symptomatic treatment was given. When the patient was about to leave the clinic, the patient suddenly collapsed with heart attack.  The patient was revived after prolonged efforts of the doctor, despite lack of equipment. During the period of resuscitation the patient’s attendees started blaming the doctor that ‘the patient came healthy but the doctor gave an injection and he died’. It was obstructing, hurting and disturbing all the time. The patient’s attendees did not shift the patient to a higher center for almost 4 hours even after the patient gained consciousness. Can a doctor reject a patient with such kind of patient and his unruly attendees?

Can the law take away the Right to freedom? It includes freedom of speech and expression, assembly, association or union or cooperatives, movement, residence, and right to practice any profession or occupation, right to life and liberty, protection in respect to conviction in offences and protection against arrest and detention in certain cases. Another right is right against exploitation: Which prohibits all forms of forced labor, child labor and traffic of human beings. Giving freedom to each and every patient to avail doctors’ services at any time, even without caring his convenience or payments looks to be violation of these rights.

No doubt in providing medical service, doctor is expected to not to discriminate against any patient on grounds such as age, gender, marital status, medical condition, national or ethnic origin, physical or mental disability, political affiliation, race, religion, sexual orientation, or socioeconomic status. This does not abrogate the physician’s right to refuse to accept a patient for legitimate reasons.” Some of these reasons could be: Trust in the relationship has been broken, patient encourages the physician commit fraud; or asks the physician to engage in illegal activity, if they fear the interference of their emotions in the procedures, if they do not really know how to treat them or the doctor is not physically or mentally well to attend the patients or the doctor has taken retirement. They can also refuse to treat a patient, if the damage done by the treatment is higher than the treatment itself, if it is too risky and did not get approval from the patient or the patient family, where the treatment is a crime e.g. abortion, fixing the virginity, stealing an organ of another person, if what the patient wants is not realistic, if the procedures are still in the experimental phase or  if the patient cannot afford the treatment.
Doctors must know the provisions in IPC to save themselves from false allegation and legal suits filed by the patient. A doctor has to inform the police without fail in following circumstances: Cases of suspected homicide, Cases of suicidal deaths, Unknown, unconscious patient, Death on operation table, Suspected unnatural death, Sudden unexpected violent and unexplained death, Instant death after treatment or reaction of medicine , Married lady dying within seven years of marriage due to any reason. Further any cases of poisoning, Accidental deaths, in cases of hospital deaths if accidents that are not related to medical management like fall from staircase etc. or unexpected complications may occur sometimes like a child may vomit, aspirate the content and may die. It is advisable to suggest postmortem in the following circumstances: Whenever death is sudden, unexpected or unexplained, Accidental deaths of any kind, , When the precise cause of death is needed for insurance claim purposes etc. If the information given is telephonic one must note down the name, buckle number and designation of the police.

Competent patients have the right to refuse treatment, even when the refusal will result in disability or death. Doctors working in a correctional home often face a situation where a convict undergoing hunger strike might refuse to receive nutrition and hydration. If the refusal involves the well-being of an unborn baby, court can override the refusal of parent.  Any surgery, procedure to save the life of the patient can be done by the attending doctor without an informed consent. However, a written consent from a family member before the procedure might come handy in case of future litigation.

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