The local medical community’s voice is growing for doctors’ rights to refuse to treat a patient, but patients are against the idea. However, the U.S. and Europe have already recognized such rights.
Based on examples in other countries, Korean physicians should also be allowed to refuse treatment in particular situations such as a forced surgery to terminate a fetus, a report said.
The Korean Medical Association (KMA)’s Medical Policy Research Institute released the report, “Status and Challenges of Treatment Refusal,” on Thursday. The institute analyzed examples in other countries and offered 12 situations where doctors can refuse to deliver treatment services.
Doctors can refuse to treat patients in US, Germany, UK, France
According to the report, the U.S. does not have a rule that bans doctors from refusing treatment in a normal situation. However, each state’s anti-discrimination law prohibits physicians from refusing to treat patients based on race, national origin, gender, sexual orientation, and religion.
The American Medical Association has AMA Principles of Medical Ethics that states detailed contents of treatment refusal.
AMA states that doctors may refuse to provide treatment in the following cases: The patient's needs are beyond the doctor's ability or area of care; the patient’s condition is non-scientific, has no medical indications, and is deemed impossible to achieve the purpose of care; the patient’s belief runs against the doctor’s personal, religious, and moral convictions that are complied with AMA’s ethics guidelines; there is no way to treat the patient safely and adequately; treating a new patient burdens patients already on treatment; and the patient abuses or threatens a doctor, a staff, or other patients.
Germany allows patients to choose a doctor and also allows physicians to refuse treatment under the “Professional Code for Physicians.” German doctors can refuse treatment in the following cases: The trust between the patient and the doctor is compromised due to the patient’s excessive behavior or failure to follow the doctor's instructions; the patient demands inefficient or non-boundary treatment; the patient demands inappropriate prescription of medicine; the doctor cannot maintain the quality of medical service due to excessive work; the patient demands treatment that is not a specialty area of the doctor; it is not an emergency, and the distance between the doctor's office and the patient's home is long, and another health insurance-covered doctor lives closer.
France limitedly allows doctors to refuse treatment. Under the French public health law, doctors have the right to refuse treatment, except in emergencies or when humanitarian obligations must be fulfilled. If a doctor refuses to provide treatment, he or she should notify this to the patient and relay the necessary information to another doctor to guarantee the continuity of treatment.
The U.K. guides doctors in ending a relationship with patients through Good Medical Practice set up by the General Medical Council (GMC).
According to GMC’s guideline for “Ending your professional relationship with a patient,” doctors can terminate the relationship in the following situations: The patient is violent, threatening, or abusive to the doctor or a colleague; the patient stole from the doctor or the premises; the patient persistently acted inconsiderately or unreasonably; or the patient made sexual advance to the doctor.
12 situations where doctors can refuse treatment
The researchers at the KMA’s medical policy institute proposed 12 situations that allow doctors to refuse to deliver medical services.
① When the doctor is absent or unable to treat a patient due to illness
② When a new patient cannot be treated due to lack of facilities or workforce such as hospital bed, medical personnel, medicines, and therapeutic materials
③ When the doctor cannot see an outpatient on the day of the patient’s visit due to the appointment schedule of the other reserved patients
④ If the medical treatment is different from the doctor’s specialty or if the doctor lacks the expertise and experience, and the doctor thinks it is effective for the patient to use another medical institution
⑤ If it is difficult to provide proper medical treatment because the doctor does not know the previous treatment (medication, procedure, surgery) that has already been applied by another doctor to the patient
⑥ If the patient aggressively demands inappropriate treatment such as opioid drugs
⑦ When the doctor orders the patient to leave the hospital based on a medical judgment that inpatient care is no longer needed
⑧ If the patient does not cooperate with the doctor’s treatment policy
⑨ If the doctor refuses to implement a decision to suspend life-extending treatment according to his or her conscience
⑩ If the doctor refuses abortion surgery according to his or her conscience
⑪ If the patient offers insult, defamation, violence, or disruptions on the doctor or a colleague
⑫ If the patient occupies or damages a medical facility
“To establish an advanced medical contract culture, it is desirable to remove the article on the prohibition of treatment refusal in the Medical Service Act and also remove the punishment article,” said Lee Eol, who led the research at the Medical Policy Research Institute. “When the trust between the patient and the doctor breaks down, the doctor should be able to refuse treatment.”