HRMR January 2015 M


THE REFUSAL OF CARE


May a healthcare professional say no to treating Ebola? It’s a thorny issue that has preoccupied many healthcare professionals in recent months.


Daniel Meier, an associate with law firm Benesch, Friedlander, Coplan & Aronoff, gives his professional opinion.


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ay a licensed healthcare professional refuse to treat a patient? Healthcare providers have legal, ethical and


professional duties to address a patient’s needs that fall within the provider’s scope of practice. However, are doctors, and other healthcare personnel, required to treat any and all patients, even if doing so might cost them their lives? While this question has arisen during the recent Ebola outbreak, it is not a new issue and has been previously addressed.


The history of refusing to treat During the early HIV/AIDS era in the 1980s, when there was little known about the disease, some physicians and other healthcare workers refused to treat HIV-infected patients. In 1992 the American Medical Association (AMA) declared in an ethics opinion that: “A physician may not ethically refuse to treat a patient whose condition is within the physician’s current realm of competence solely because the patient is seropositive for HIV. Persons who are seropositive should not be subjected to discrimination based on fear or prejudice”—AMA Opinion 9.131 (March 992, updated June 1996 and June 1998). Similarly, the American Dental Association


stated in its Principles of Ethics and Code of Professional Conduct that: “A dentist has a general obligation to provide care to those in need. A decision not to provide treatment to an individual because the individual has AIDS or is HIV seropositive based solely on that fact is unethical.”—American Dental Association, ADA Principles of Ethics and Code of Professional Conduct III §4.A.1 (2012). During the recent Ebola outbreak, healthcare personnel were once again refusing to treat infected patients. Is this acceptable?


The right to be treated The Emergency Medical Treatment and Active Labor Act (EMTALA) is a federal law that requires that any patients who present at an emergency department must be stabilized and treated in a non-discriminatory manner, regardless of their insurance status, ability to pay, national origin, race, creed or color (42 USC §1395dd). Hospitals may not transfer or discharge


patients needing emergency treatment except with the informed consent (itself a legal doctrine) or stabilization of the patient, or when their condition requires transfer to a hospital better equipped to administer the treatment. Since Ebola qualifies as an emergency medical condition, patients with the disease


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