*Dr. R.V. Capule is an attorney specializing in medical malpractice, physical injuries and food torts. He is a law professor of Legal Medicine at Arellano University School of Law and a consultant in Legal Medicine at Manila Adventist Medical Center and Makati Medical Center. In the olden times, a physician is free to choose his own patient or exercise his right to refuse a patient for any reason or for no reason at all. Nowadays, there are laws or consensual contracts that mandate a physician to treat a patient in a given circumstance, and refusing such patient may create liability. Under the law 1 a physician cannot refuse to render immediate emergency medical assistance to patients who are in danger of dying and/or who may have suffered serious physical injuries. The law only contemplates patients who are brought to the emergency room or a clinic. If the patient is not in danger of dying or only sustained less serious or slight physical injuries, then the law will not apply. Refusal to render treatment for non-payment of deposit or advance payment is also sanctioned by the law. 2 The Code of Ethics of the Philippine Medical Association further provides that [a] physician should be free to choose patients. 3 Nonetheless, the code expressly provided an exception in choosing patients, thus, [in] an emergency, provided there is no risk to his or her safety, a physician should administer at least first aid treatment and then refer the patient to the primary physician and/or to a more competent health provider and appropriate facility if necessary. 4
A physician cannot refuse to render at least first aid treatment provided it will not endanger his personal safety. In the same tenor, the Medical Act of 1959 5
can revoke or suspend the license of a physician if he refused to attend a patient in danger of death without any risk to his life. Both the Code of Ethics and the Medical Act of 1959 impose a duty not to refuse a patient with emergency medical condition or a patient in danger of death as long as rendering treatment will not cause harm to a physician. Conversely, if treating such patient will endanger the life of the physician, law and ethics will not sanction refusal to treat. Interestingly, some contractual obligations can curtail a physicians right to choose patients. When a corporation or any establishment enters into a retainership agreement with a physician, in reality such corporation or establishment is simply securing the future services of the physician. In other words, the physician is already consenting to treat future patients provided for in the retainership agreement. He cannot just refuse to treat that patient unless for cause. Company physicians, school physicians, Philhealth professional healthcare providers and HMO healthcare providers, to name a few, are bound to treat patients provided for by their contracts. Under this circumstance, a physician is already bound by a physician-patient relationship with a future patient. Knowingly or otherwise, a physician has abdicated his right to choose patients. It would be best to remember that the obligatory nature of the medical profession arises when a physician 1) voluntarily holds himself out in the community as a practicing physician and the person is in need of urgent medical care and 2) has entered into an expressed contract to render service. 6 Lastly, can one refuse a previously disruptive or uncooperative patient? How about a patient who has not paid his obligation from his previous consultation or admission? These situations should be treated with caution. Under the spells of illness doctrine, the consensual contract between the patient and physician will be valid only during the existence of the disease which prompted the consultation. In other words, for every subsequent illness a new contract is required. This applies both to in-patient or out-patient treatment. If consultations are made during the existence of a physician-patient relationship, refusal to treat might be interpreted as abandonment. The moment the previous physician-patient relationship or the retainership agreement has ended, refusing to treat a disruptive patient or a non-paying patient will not create any liability, unless such patient is in danger of dying at the time of consultation. References 1. R. A. 6615 An act Requiring Government and Private Hospitals and Clinics to Extend Medical Assistance in Emergency Cases 2. R.A. 8344 An Act Prohibiting the Demand of Deposits or Advance Payments 3. Section 2 Article II 4. Section 3 Article II 5. Section 24 R.A. 2382 6. Can I Refuse Patients?, Legal Prescription for Doctors; Phil. J. Internal Medicine, 42; July-August, 2004 Legal Prescription Philippine Journal of Internal Medicine