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To treat or not to treat? 

10 May 2022

  • Doctors and the public weigh in on the complex grey area over whether a doctor can refuse to treat a specific patient
BY Sumudu Chamara In many contexts, certain professions are usually viewed as more of a service than a profession, and practitioners are viewed as people who perform a service to their community; such as the medical profession. In Sri Lanka, doctors are often assigned the value of life-saving gods, while at the same time, many people feel that doctors are obliged to provide their services with no restrictions.  However, a recent discourse on doctors’ rights, limits, obligations, and responsibilities when it comes to treating patients has highlighted the need to be clear about doctors’ right to refuse treatment for a patient. This discourse is centred around the grounds on which a doctor can refuse to provide services to a patient, and how ethical it is to do so.  This discourse was sparked by the occurrence of such an incident reported last week, when Clinical Nutritionist Prof. Ranil Jayawardena, who is a Senior Lecturer at the Colombo University Medical Faculty’s Physiology Department, had refused to treat then-Minister of Public Security and Tourism Prasanna Ranatunga at Lanka Hospitals in Colombo due to the former’s dissatisfaction with the present Government, of which the Minister was an active member.  No treatment for the Minister  Speaking to the media following the said incident, Prof. Jayawardena said that given the economic hardships that the country is facing at present, he did not want to treat Ranatunga, and that as a doctor, he had the right to decide whether or not to see a patient. He also noted the importance of treating every patient alike, adding that politicians should not be given special treatment.  In an emergency situation, he noted, it is not possible for a doctor to postpone treatment. However, Prof. Jayawardena also pointed out, his refusal to treat Ranatunga had not breached any ethical or moral standards, and that no harm had been caused.  Amidst this debate, the management of Lanka Hospitals Corporation PLC had, on Sunday (8), issued a press release regarding the incident, claiming that any refusal by a consultant to meet a patient remains a decision at the discretion of the consultant. Adding that the hospital would ensure that the protocols that need to be followed after the cancellation of an appointment are fully complied with, it also confirmed that it had not barred any medical consultant from engaging or continuing practice at the hospital over the reported incident, contrary to what is alleged on social media platforms.  “We assure the general public that the hospital is fully geared and takes responsibility to ensure the well-being and privacy of patients seeking medical assistance at our facilities. We also urge the general public to respect the rights and privacy of patients under all circumstances,” the press release further read.  Doctor-patient relationship  Speaking in this regard, a Colombo-based doctor, speaking on the condition of anonymity, told The Morning that a doctor should have a right to refuse to treat a patient, and that a doctor should be under no obligation to treat every patient that wishes to see them.  “A doctor-patient relationship is not, and cannot be, a forced one. It is based on a patient’s need and willingness to see a doctor, and a doctor’s need, be it financial or otherwise, and willingness to see a patient. It is a mutual agreement, which requires the consent of both parties. The doctor has a right to be aware of the health reasons regarding which the patient wants to see the doctor, in order to be sure that the doctor can satisfactorily treat the patient. At the same time, a doctor cannot be forced to treat a patient he/she is not willing to treat, regardless of the reason.”  He, however, explained that the same rights extend to patients as well, stating: “The patient too has a right to inquire about the doctor that they are receiving treatment from. That is why all patients obtaining services from paid or private healthcare facilities and also certain leading public healthcare facilities are informed of the doctor that they are scheduled to see, in advance.  “They have a right to know about a doctor’s qualifications, experience, and other details that are important to them when choosing a doctor, before being treated. They have a right to refuse to see a doctor on any ground that they think is valid, and request another suitable doctor, especially if the patient is paying for treatment. In this instance too, we cannot force a patient to see a doctor the former does not want to see.” The doctor also noted that ensuring that both the patient and the doctor are comfortable with each other is crucial, and that it has a direct impact on the treatment and the overall doctor-patient relationship. Failure to ensure this compatibility, he said, can be harmful to both the patient and the doctor. However, he also said that the freedom to refuse to treat a patient should be available only under certain conditions. “A doctor should be willing to treat any patient that is in need of medical assistance in emergencies, and when there is a lack of doctors. A doctor should be allowed to refuse to see a patient only if the patient has the resources to seek another doctor’s service before the patient’s health conditions could pose a threat to their life,” he said, adding that a patient’s well-being should always be prioritised by doctors and all other ethical and professional standards should be based on that principle. Another doctor working at a leading private hospital noted that refusing to treat a patient is a basic right any doctor should have. He also noted that the discourse based on the aforementioned incident should not be limited to that specific incident and should be about the overall doctor-patient relationship. He added: “Society blames doctors when they refuse to treat a patient. What they do not discuss is that patients can also refuse to see a doctor that they do not want to get treatment from. Both parties have that right, for the well-being of both parties.”  He however noted that if a doctor refuses to treat a patient in a critical situation, that would be considered a failure to fulfil their duties, and is not a right granted to them.  “The decision to refuse treatment should be fair to both the parties and not cause any harm or inconvenience,” he added. Several other doctors that The Morning contacted said that the decision as to whether to see a patient or not has to be taken after taking many factors into account, and refused to comment on the matter further.  Voice of the people  The public were of the opinion that a doctor should not be concerned about a patient’s personal life or choices unless it concerns the doctor on a personal level, or unless such decisions have something to do with the patient’s health situation, and therefore, a patient’s personal life or choices should not be grounds to refuse to see a patient. They, however, agreed that a doctor should have a right to refuse to see a patient on valid reasons.  “If a doctor does not want to see a patient, there is no need to force him/her to do that. However, I think that the doctor owes the patient an explanation as to why he/she does not wish to see the patient, especially if the patient has paid to make an appointment to get treated by a doctor. If the doctor should be given the right to cancel an appointment, the patient should have the right to know what reasons led to such cancellation,” K.C. Sanath Perera, a retired public sector employee, told The Morning.  He opined that since the doctor-patient relationship is a professional one, a doctor should be allowed to cancel appointments only if there are reasons that are valid in a professional context, not in a personal context.  “If a doctor is not sure about whether he can treat a certain health condition or if a doctor does not have enough time to see a patient, it is completely alright to cancel an appointment. I think that the only personal reasons that can be considered as acceptable reasons to refuse to see a patient are conflicts of interest and a breach of what has been agreed to by the two parties as part of the doctor-patient relationship.” Kelum Samaratunga, a 33-year-old entrepreneur, however, opined that regardless of the nature of the reasons, if either a doctor or a patient is not feeling comfortable when dealing with each other, they should have the freedom to change the terms and conditions of, or cancel, an appointment.  “We are all humans, and what we feel affects what we do. If a doctor is not comfortable treating a certain patient due to some reason, that means that the doctor is not going to be able to perform his duties well and deliver what is expected by the patient. The same can happen on the part of a patient. If a patient is not happy with a certain doctor, the former may not be cooperative when dealing with the doctor and it can affect the results of the treatments,” he said, emphasising that due to this situation, regardless of the reason, both parties should have the opportunity to cancel appointments. He further said that healthcare facilities that facilitate making appointments with doctors also have a huge role in ensuring that such cancellations or change of the terms and conditions of an appointment are handled diplomatically and swiftly, in order to avoid any inconvenience to any party.  Ethics  There are a plethora of diverse standards in the international medical community with regard to a doctor’s right to refuse treatment for a patient. In most cases, such refusal is accepted only in certain situations. While doctors are not permitted to refuse to treat patients who are in immediate need of care, doctors in emergency departments or in ambulances usually have a legal obligation to treat any patient that seeks or is in need of medical treatment. By international standards, a doctor can refuse to treat a patient only if the doctor is certain that such refusal does not endanger the life of the patient, and that the patient has access to equally suitable alternatives.  According to the Sri Lanka Medical Council’s (SLMC) issued instructions, titled “Serious Professional Misconduct to Medical Practitioners and Dentists”, refusing to treat a patient is permitted only under certain conditions. It reads: “You must treat your patients with respect whatever their life choices and beliefs are” and “if carrying out a particular procedure or giving advice about it conflicts with your religious or moral beliefs, and this conflict might affect the treatment or advice you provide, you must explain this to the patient and tell him/her that they have the right to see another doctor”. The Morning’s attempts to get the views of several leading medical associations with regard to the ethical aspect of this matter were unsuccessful. While there are various views about a doctor’s right to refuse treatment for valid reasons, what most of the people who spoke with The Morning agreed was that such refusal should be done in a manner that does not harm or inconvenience the patient. At the same time, the importance of proper coordination and communication between doctors and patients was highlighted.  It is crucial that the terms and conditions on which the doctor-patient relationship is based also evolves in a manner that improves that relationship. 


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