Patients’ consent to submit to treatment and the refusal to treat patients are two crucial aspects, representing the rights of patients and doctors respectively. A Vadodara-based gynecologist recently shared (Ankita Sengupta (2024, April 23) Why this Gujarat gynecologist refused to treat a pregnant woman in her 30s: ‘Have the right to…’, Money Control website) his experience of being compelled to decline treatment to a pregnant patient in her thirties. This patient had disregarded medical advice and refused to undergo important tests, influenced by her non-medical friends. The new medical regulations, the “National Medical Commission Registered Medical Practitioner (Professional Conduct) Regulations, 2023 (“Regulations 2023”), emphasize under what circumstances, the Doctor’s has right to refuse treating the patient. The present article outlines the same.
2002 Regulation governing Professional Conduct of Doctors
The Regulations, 2023 replaces the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 (“2002 law”), which were previously established by the Medical Council of India (“MCI”) (Responsive WebInc. (n.d.). Indian Medical Council (Professional Conduct, Etiquette And Ethics) Regulations, 2002, Website) Before its dissolution, the MCI was the regulatory body responsible for maintaining standards in the Indian medical profession. Under the law, the Doctor’s right to refusal was on the following two grounds-
According to Section 2.1 of the 2002 Law, physicians can suggest that their patients seek treatment from another physician. However, in an emergency, the treating physician must provide the necessary treatment to the patient. Physicians are not allowed to refuse treatment to a patient without a valid reason. However, suppose the patient is suffering from an ailment that is beyond the experience of the treating physician. In that case, they may refuse treatment and refer the patient to another physician with the necessary expertise to provide the best possible care.
According to Section 7.15 of the 2002 Law, a registered medical practitioner cannot deny assistance or conduct procedures such as sterility, birth control, circumcision, and medical termination of pregnancy if there is a medical indication. However, if the medical practitioner feels that they are not competent to do so, they may refuse. It is unacceptable for a medical practitioner to refuse assistance based solely on religious grounds.
New Regulation of 2023
The National Medical Commission (NMC) has taken a proactive step by notifying new regulations, which may include guidelines concerning the refusal of treatment and referral of patients to other health facilities. The NMC Registered Medical Practitioner (Professional Conduct) Regulations 2023 (Government of India, National Medical Commission Ethics and Medical Registration Board Notification, The Official Gazette Notification, 2023, page 70-124) aim to establish ethical and professional standards for registered medical practitioners in India, fostering a sense of trust and confidence in the healthcare system. Under the new Regulation 2023:
Section 6: Right to Remuneration- Doctors have the right to be paid for their services. Consultation fees should be discussed with the patient before any examination or treatment occurs. The Doctor should provide the patient with an estimate of the cost of surgery or treatment to help them make an informed decision. If the patient refuses to pay the indicated fees, the Doctor can refuse treatment or continue to treat the patient, but they must ensure that the patient is not abandoned. However, this rule does not apply to doctors who work for the government or in emergencies.
Section 18: Registered Medical Practitioner must not refuse medical procedures such as sterilization, circumcision, contraception, or termination of pregnancy if a medical reason exists, regardless of religious beliefs.
Section 26: Patient Care- When it comes to patient care, a Registered Medical Practitioner (RMP) has the right to choose whom they will serve, unless there is an emergency. Once an RMP accepts a patient’s case, they should provide proper care and not abandon the patient without prior notice. If a situation arises where the patient needs to see another RMP for a particular procedure, the patient or their guardian should provide consent. The RMP who provides care to the patient will be held accountable for their actions and will be entitled to the appropriate fees. In the event of abusive, violent or unruly behavior from the patient or their relatives, the RMP can report the behavior and refuse to treat the patient. Such patients should be referred to other healthcare providers for further treatment.
In conclusion, patient consent to treatment and the right of doctors to refuse treatment are fundamental aspects that uphold the rights of both patients and healthcare providers. The new medical regulations, the Regulations, 2023, provide guidelines on the circumstances under which doctors can refuse treatment, ensuring ethical and professional standards are maintained. Under the previous regulations of 2002, doctors had the right to refuse treatment in certain circumstances, such as when they lacked the expertise to provide necessary care or when there were medical indications for procedures like sterilization or termination of pregnancy. However, the new regulations of 2023 reinforce these principles and add provisions to address issues like right to remuneration, patient care, and handling of abusive behavior from patients or their relatives. Section 6 of the Regulations 2023 affirms the right of doctors to be remunerated for their services and outlines procedures for discussing fees with patients and providing estimates for treatment costs. Section 18 emphasizes that medical procedures should not be refused based on religious beliefs if there is a medical reason for the procedure. Section 26 of Regulation 2023 reinforces the importance of patient care and the right of doctors to choose whom they will serve, with exceptions for emergencies. It also provides guidelines for handling situations where patients exhibit abusive behavior. Overall, the Regulations 2023 aim to uphold ethical standards, foster trust in the healthcare system, and ensure that both patients and healthcare providers are treated with respect and dignity. By adhering to these regulations, doctors can fulfill their obligations to provide quality care while respecting the rights and autonomy of their patients.
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