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What obligations do doctors have to patients?

What Is a Doctor’s Duty of Care?

The last updated date refers to the last time this article was reviewed by FindLaw or one of our contributing authors. We make every effort to keep our articles updated. For information regarding a specific legal issue affecting you, please contact an attorney in your area.

  • Time limits to bring a lawsuit, also known as statutes of limitations
  • Whether the theory of liability under consideration is a «cognizable» one—or one a court determines it possesses the authority to review
  • Whether the parties actually qualify to be either the defendant or the plaintiff in a medical malpractice claim—or that they are «proper» parties to this particular variety of lawsuit
  • The qualifications for an «expert» witness

More generally speaking, like other negligence claims, medical malpractice claims hinge upon the following, which speak to the duty a physician owes their patient:

  • Standards of care
  • The «reasonable person» standard
  • The doctor’s duty of care to the patient

See FindLaw’s Medical Malpractice Liability and Medical Malpractice Legal Help sections for more articles and resources.

Physician Owes a Duty

It isn’t possible to prove your doctor’s liability until you demonstrate that your physician owed you a duty of care. If you cannot demonstrate that, your doctor’s conduct cannot be evaluated in meaningful ways.

Generally speaking, a person has no affirmative duty to assist injured persons in the absence of a special relationship with them. Examples of such a relationship include the bond between a doctor and their patient, an attorney and their client, and a guardian and their ward.

It is only in your relationship with your doctor, as their patient, that you can establish a duty of care. For example, a doctor dining in a restaurant has no affirmative duty to assist a fellow customer who is suffering a heart attack. If the doctor merely continues eating and does not come to the aid of that fellow customer, the cardiac arrest sufferer would not have a viable cause of action for malpractice against the doctor. But once a doctor decides to assist others and actually engages in the act of caretaking, as they have done with you, they become liable for any injury that results from negligence during the course of care. They may also be liable for injuries caused as a result of that care.

In other words, it is not until you enter into a relationship with a doctor, as your doctor, that they owe you this duty. Your doctor’s conduct must measure up to the skills, quality of care, and level of diligence possessed by, or expected of, other reasonably competent physicians. And your doctor’s conduct at any given time must also measure up to that of other reasonably competent physicians in the same or similar circumstances as those that you believe resulted in your injury.

When gauging whether your doctor has conducted themselves in this way, the following are always crucial to consider:

  • The area of medicine in which your physician practices
  • The customary or accepted practices of other physicians in your doctor’s area of expertise (which is known as the «locality rule»)
  • The level of equipment and facilities available at the time and where the medical care was provided
  • Any urgent or unexpected demands of the circumstances, if any, surrounding the medical services that were given

«Expert witnesses» are required to assess all of these things. To qualify as an expert that can speak to whether your doctor violated their duty of care, such a witness typically would need to share the same or similar skills with your doctor. In general, they might also need to possess the same level and type of training, certification, and experience.

Vicarious Liability

A doctor who has been negligent may not be the only defendant in a medical malpractice lawsuit. The hospital where your doctor works as a staff member, for example, could also be held liable. Through a theory of liability known as «respondeat superior,» what is known as «vicarious liability» could be at play. Translating from the Latin as «let the master answer,» such a theory allows for an employer to be held liable for the negligence of its employees.

Often, however, hospitals give doctors «staff privileges.» Referring to these privileges, the hospital might attempt to prove the limited role it plays in directing or supervising the work of each member of its medical staff. Many doctors also belong to private medical practices, such as limited partnerships or limited liability companies. Through theories of vicarious liability, these groups could also be held liable.

Of equal importance is how a doctor is generally liable for their assistants’ and staff members’ negligence when those individuals are carrying out a doctor’s orders or caring for patients. Likewise, an attending physician is generally liable for any negligence on the part of interns and medical students under the physician’s guidance. To put it another way, under these circumstances, the doctor or attending physician assumes the duty of care.

Get a Legal Evaluation of Your Malpractice Claim

If you have suffered injuries as a result of your medical care, you may be able to claim damages if your doctor or medical care provider was negligent. Evaluating the facts in a medical malpractice claim requires significant expertise. Typically, such claims are not straightforward for so many reasons. To find out whether a physician was negligent in their duty of care, you may want to contact an experienced legal professional.

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Not so conscientious objection: When can doctors refuse to treat?

doctor

I n overturning the Trump administration’s attempt to expand the so-called conscience rule for health care workers this week, a federal judge has brought renewed attention to a long-simmering debate in medicine over when doctors can decline to provide treatment to patients without abdicating their professional responsibilities.

The revised rule, issued last spring by the Department of Health and Human Services, was aimed at protecting doctors, nurses, and others from, in the words of HHS, being “bullied out of the health care field” for refusing to participate in abortions, gender reassignment surgery, or other medical procedures based on religious beliefs or conscience. Critics of the rule charge that it would enable discrimination by allowing providers to deny health care to certain patients, particularly women and LGBTQ+ individuals.

U.S. District Judge Paul Engelmayer ruled that HHS overstepped its authority, though the rule sought to “recognize and protect undeniably important rights.” But what are those rights, and in what circumstances can physicians ethically withhold treatment that a patient wants?

There are three general contexts in which it is permissible and sometimes obligatory to refuse care: when doctors are subjected to abusive treatment, when the treatment requested is outside a doctor’s scope of practice, or when providing the requested treatment would otherwise violate one’s duties as a physician, such as the Hippocratic mandate to “first do no harm.” But none of these rationales can justify physicians denying care based on their personal beliefs.

When patients are abusive

If a patient walks into my office using threatening language or behaving violently toward me or my staff and fails to improve his behavior despite good-faith attempts at redirection, I can ask him to leave without receiving care. Of course, there may be extenuating circumstances. A patient in the midst of a mental health crisis who is abusive clearly requires immediate attention. And a critically ill patient who comes to the emergency room engaging in violent behavior but desperately in need of care cannot be dismissed, as this would cause her immediate harm, though security personnel may be required to assist in the delivery of care. Still, in the absence of urgent care needs, I am within my rights to not provide treatment to an abusive patient rather than allow him or her to continue with behavior that disrupts the care of other patients or threatens my safety or that of other health care workers.

Scope of practice limitations

Doctors should not provide treatment outside their scope of practice. As a cardiologist, I have expertise in treating cardiovascular disease and its risk factors, but I do not manage non-cardiac conditions. If a patient of mine with heart disease asks me for pain medication for a lower back strain or antibiotics for an ear infection, I should decline to provide this treatment because it is outside my area of practice or expertise. I should, however, advise him on how best to proceed by referring him back to his primary care physician.

While that may be an inconvenience to my patient, my providing non-cardiac treatment without being up to date on current guidelines and practice standards presents a real potential for harm. My prescribing the wrong antibiotic, for example, might delay him from getting the right treatment and put him at higher risk for infectious complications, which would violate my duty as a physician to do no harm.

Upholding physician duties

The third context in which doctors can refuse to provide certain treatments deserves a closer look. Patients seek care from physicians not only to treat illness but also to promote wellness and flourishing, and physicians have duties to provide this care to the best of their abilities. These include the imperatives to respect patient autonomy, to improve quality of life and longevity when possible, to alleviate suffering, to promote fair allocation of medical resources, and, perhaps most importantly, to avoid doing harm.

When a patient’s request comes into conflict with these duties, a doctor may need to refuse it — though he or she is obligated to do so with kindness and an appropriate explanation of the rationale.

Consider antibiotics again as an example. If a patient comes to her primary care physician seeking treatment for ear pain and requests antibiotics, but the exam points to a viral rather than bacterial process, her doctor can and should refuse to prescribe antibiotics.

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First off, antibiotics are not effective against viral infection and thus provide no benefit. In addition, all medications carry the potential to cause harmful side effects. Prescribing antibiotics in this situation would place the patient at an admittedly small risk of harm with zero chance of benefit.

Second, inappropriate antibiotic prescriptions contribute to the growing problem of antibiotic resistance, which causes harm to society and thus violates a physician’s duty to act as a steward of medical resources.

Opioids offer another example. These medications can provide powerful pain relief, but their use may expose patients to a significant risk of abuse and addiction. As such, they require judicious prescribing. Not all pain warrants their use, and they should not be prescribed to placate patients if they are not indicated, no matter how strongly they are requested.

While a physician’s refusal to prescribe antibiotics or opioids may disappoint a patient and potentially result in negative patient satisfaction reviews, physicians are obligated to do no harm and promote wellness over the dubious metric of satisfaction surveys. The customer may always be right, but the patient is not a customer or a client.

We have seen the pendulum of medical ethics swing from a focus on beneficent paternalism (the doctor knows best) toward a focus on autonomy (the patient knows best). I think the right path lies in between. In a typical patient encounter, after I explain my diagnostic and treatment plan to a patient, I ask if it makes sense and if he is on board. The response is often, “Doc, you’re the boss!” to which I invariably reply, “I am the expert, but you are the boss.”

In other words, the patient’s goals and values should dictate treatment, while it is the doctor’s duty to propose potential approaches that are in line with those values and review options to determine the best path toward achieving those goals. Doctors should not try to force treatments upon patients that conflict with their values, and patients should not try to coerce doctors into providing treatments that are medically inappropriate.

Conflicting physician duties

There are some situations in which professional duties inevitably come into conflict with each other. Several states have legalized physician-assisted suicide, though typically with strict criteria such as the need for multiple physicians to confirm the presence of terminal disease and psychiatric evaluation to exclude treatable mental illness. The ethics of physician-assisted suicide are controversial, with compelling moral arguments on both sides of this debate.

Those in favor cite the imperative to respect patient autonomy or right to self-determination, as well as doctors’ duty to relieve suffering. Those opposed argue that helping a patient take her own life profoundly violates the principle of non-maleficence or avoiding harm. This is a situation in which conscientious objection may be ethically invoked. Doctors may ethically decline to participate in physician-assisted suicide if they believe that doing so would violate their professional duties. That said, they should make a good-faith effort to refer the patient to another physician who might be more inclined to consider such a request.

Related: I’m a doctor with end-stage cancer. I support medical aid in dying

It is not, however, ethical to refuse a patient’s request for treatment simply on the basis of personal beliefs, including religion. Much like our country’s founding principles that enshrine the separation of church and state, medical ethics must recognize the boundaries between church and medicine.

American moral and legal theory have traditionally embraced the Rawlsian conception of liberty — the idea that individual liberty must be respected and protected until one individual’s action encroaches upon another’s liberty. For example, a person does not have the right to act violently toward another because this action robs the second individual of his right to freedom from violence. Through this lens, the term “religious liberty” is disingenuous in that it actually limits the liberty of patients to receive medical care free from the constraints of a clinician’s religion that his or her patients may or may not embrace.

Here is a secular example to illustrate this point. I am a pesco-vegetarian who has chosen to follow a predominantly plant-based diet for health and environmental reasons, and also because I object to factory farming practices involving the slaughter of animals to produce meat. As a cardiologist, my duty is to provide the best evidence-based heart care for my patients. This, of course, includes counseling them on the significant cardiovascular benefits of a plant-based diet in addition to prescribing medications as needed. But I have no business trying to coerce them into adopting my position on food by trying to morally shame them out of their current habits or by refusing to prescribe a cholesterol-lowering medication because that would enable or encourage their consumption of meat.

I cannot imagine anyone would argue that it would be ethically permissible for me to refuse to treat patients who eat meat after having had a heart attack because I object to their diets. This would be morally (and legally) unacceptable. In the same vein, it is no more permissible for physicians to refuse or alter their care of patients based on religious convictions.

It is unethical for a physician to deny care to LGBTQ+ patients because of personal objections about whom his or her patients choose to love in their private lives. It is unethical to refuse to prescribe contraception to single individuals because of personal or religious objections to premarital or nonprocreative sex.

Abortion is a thornier issue because a legitimate metaphysical argument can be made that life begins at conception and, similar to physician-assisted suicide, performing an abortion could be seen as violating a physician’s duty to preserve life and avoid doing harm. Yet forcing women to carry unwanted pregnancies fundamentally violates their autonomy, and thus their personhood.

Abortion is an essential part of health care in that it must sometimes be performed to preserve the health or life of the mother, and in other cases it is necessary to ensure a woman’s right to self-determination as an autonomous adult. While physicians should be allowed some discretion if they truly believe performing an abortion in certain cases would violate their duties as a medical professional, those who would be unwilling to perform abortions under any circumstances for religious reasons are not well suited for reproductive health care.

When objection is not conscientious

While there circumstances such as the ones I described earlier in which physicians can and should decline to provide treatment, the so-called conscience rule goes too far in its allowances. For example, if a pregnant woman comes to the emergency room at night in distress due to what doctors subsequently deem a life-threatening complication of pregnancy and they recommend termination because her fetus is not yet viable, members of the on-call team cannot morally refuse to assist in her abortion. In this urgent situation, unnecessary delays in care from trying to call in additional staff or refer her to another facility may cause her irreparable harm.

It is not a physician’s job to tell patients how to live according to the physician’s personal code of ethics, whether religious or secular. Nor should a physician withhold treatment from patients simply because they fail to adhere to his or her personal standards of morality. Rather, a physician’s duty is to promote patients’ wellness and flourishing through the application of evidence-based medicine to the best of his or her professional ability. Personal beliefs, religious or otherwise, must not interfere with that.

There is nothing conscientious about doctors objecting to caring for patients when we simply disagree with how our patients live their lives. It is unethical for doctors to bully patients in the name of our personal convictions — a blatant violation of our professional duty. We owe it to ourselves and to our patients to hold our profession to a higher standard.

Sarah C. Hull, M.D. is a cardiologist at Yale School of Medicine and associate director of its Program for Biomedical Ethics.

WMA International Code of Medical Ethics

Adopted by the 3 rd General Assembly of the World Medical Association, London, England, October 1949
Revised by the 22 nd World Medical Assembly, Sydney, Australia, August 1968,
the 35 th World Medical Assembly, Venice, Italy, October 1983,
the 57 th WMA General Assembly, Pilanesberg, South Africa, October 2006
and by the 73 rd WMA General Assembly, Berlin, Germany, October 2022

Preamble

The World Medical Association (WMA) has developed the International Code of Medical Ethics as a canon of ethical principles for the members of the medical profession worldwide. In concordance with the WMA Declaration of Geneva: The Physician’s Pledge and the WMA’s entire body of policies, it defines and elucidates the professional duties of physicians towards their patients, other physicians and health professionals, themselves, and society as a whole.

The physician must be aware of applicable national ethical, legal, and regulatory norms and standards, as well as relevant international norms and standards.

Such norms and standards must not reduce the physician’s commitment to the ethical principles set forth in this Code.

The International Code of Medical Ethics should be read as a whole and each of its constituent paragraphs should be applied with consideration of all other relevant paragraphs. Consistent with the mandate of the WMA, the Code is addressed to physicians. The WMA encourages others who are involved in healthcare to adopt these ethical principles.

General principles

1. The primary duty of the physician is to promote the health and well-being of individual patients by providing competent, timely, and compassionate care in accordance with good medical practice and professionalism.

The physician also has a responsibility to contribute to the health and well-being of the populations the physician serves and society as a whole, including future generations.

The physician must provide care with the utmost respect for human life and dignity, and for the autonomy and rights of the patient.

2. The physician must practise medicine fairly and justly and provide care based on the patient’s health needs without bias or engaging in discriminatory conduct on the basis of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, culture, sexual orientation, social standing, or any other factor.

3. The physician must strive to use health care resources in a way that optimally benefits the patient, in keeping with fair, just, and prudent stewardship of the shared resources with which the physician is entrusted.

4. The physician must practise with conscience, honesty, integrity, and accountability, while always exercising independent professional judgement and maintaining the highest standards of professional conduct.

5. Physicians must not allow their individual professional judgement to be influenced by the possibility of benefit to themselves or their institution. The physician must recognise and avoid real or potential conflicts of interest. Where such conflicts are unavoidable, they must be declared in advance and properly managed.

6. Physicians must take responsibility for their individual medical decisions and must not alter their sound professional medical judgements on the basis of instructions contrary to medical considerations.

7. When medically appropriate, the physician must collaborate with other physicians and health professionals who are involved in the care of the patient or who are qualified to assess or recommend care options. This communication must respect patient confidentiality and be confined to necessary information.

8. When providing professional certification, the physician must only certify what the physician has personally verified.

9. The physician should provide help in medical emergencies, while considering the physician’s own safety and competence, and the availability of other viable options for care.

10. The physician must never participate in or facilitate acts of torture, or other cruel, inhuman, or degrading practices and punishments.

11. The physician must engage in continuous learning throughout professional life in order to maintain and develop professional knowledge and skills.

12. The physician should strive to practise medicine in ways that are environmentally sustainable with a view to minimising environmental health risks to current and future generations.

Duties to the patient

13. In providing medical care, the physician must respect the dignity, autonomy, and rights of the patient. The physician must respect the patient’s right to freely accept or refuse care in keeping with the patient’s values and preferences.

14. The physician must commit to the primacy of patient health and well-being and must offer care in the patient’s best interests. In doing so, the physician must strive to prevent or minimise harm for the patient and seek a positive balance between the intended benefit to the patient and any potential harm.

15. The physician must respect the patient’s right to be informed in every phase of the care process. The physician must obtain the patient’s voluntary informed consent prior to any medical care provided, ensuring that the patient receives and understands the information needed to make an independent, informed decision about the proposed care. The physician must respect the patient’s decision to withhold or withdraw consent at any time and for any reason.

16. When a patient has substantially limited, underdeveloped, impaired, or fluctuating decision-making capacity, the physician must involve the patient as much as possible in medical decisions. In addition, the physician must work with the patient’s trusted representative, if available, to make decisions in keeping with the patient’s preferences, when those are known or can reasonably be inferred. When the patient’s preferences cannot be determined, the physician must make decisions in the patient’s best interests. All decisions must be made in keeping with the principles set forth in this Code.

17. In emergencies, where the patient is not able to participate in decision making and no representative is readily available, the physician may initiate an intervention without prior informed consent in the best interests of the patient and with respect for the patient’s preferences, where known.

18. If the patient regains decision-making capacity, the physician must obtain informed consent for further intervention.

19. The physician should be considerate of and communicate with others, where available, who are close to the patient, in keeping with the patient’s preferences and best interests and with due regard for patient confidentiality.

20. If any aspect of caring for the patient is beyond the capacity of a physician, the physician must consult with or refer the patient to another appropriately qualified physician or health professional who has the necessary capacity.

21. The physician must ensure accurate and timely medical documentation.

22. The physician must respect the patient’s privacy and confidentiality, even after the patient has died. A physician may disclose confidential information if the patient provides voluntary informed consent or, in exceptional cases, when disclosure is necessary to safeguard a significant and overriding ethical obligation to which all other possible solutions have been exhausted, even when the patient does not or cannot consent to it. This disclosure must be limited to the minimal necessary information, recipients, and duration.

23. If a physician is acting on behalf of or reporting to any third parties with respect to the care of a patient, the physician must inform the patient accordingly at the outset and, where appropriate, during the course of any interactions. The physician must disclose to the patient the nature and extent of those commitments and must obtain consent for the interaction.

24. The physician must refrain from intrusive or otherwise inappropriate advertising and marketing and ensure that all information used by the physician in advertising and marketing is factual and not misleading.

25. The physician must not allow commercial, financial, or other conflicting interests to affect the physician’s professional judgement.

26. When providing medical care remotely, the physician must ensure that this form of communication is medically justifiable and that the necessary medical care is provided. The physician must also inform the patient about the benefits and limitations of receiving medical care remotely, obtain the patient’s consent, and ensure that patient confidentiality is upheld. Wherever medically appropriate, the physician must aim to provide care to the patient through direct, personal contact.

27. The physician must maintain appropriate professional boundaries. The physician must never engage in abusive, exploitative, or other inappropriate relationships or behaviour with a patient and must not engage in a sexual relationship with a current patient.

28. In order to provide care of the highest standards, physicians must attend to their own health, well-being, and abilities. This includes seeking appropriate care to ensure that they are able to practise safely.

29. This Code represents the physician’s ethical duties. However, on some issues there are profound moral dilemmas concerning which physicians and patients may hold deeply considered but conflicting conscientious beliefs.

The physician has an ethical obligation to minimise disruption to patient care. Physician conscientious objection to provision of any lawful medical interventions may only be exercised if the individual patient is not harmed or discriminated against and if the patient’s health is not endangered.

The physician must immediately and respectfully inform the patient of this objection and of the patient’s right to consult another qualified physician and provide sufficient information to enable the patient to initiate such a consultation in a timely manner.

Duties to other physicians, health professionals, students, and other personnel

30. The physician must engage with other physicians, health professionals and other personnel in a respectful and collaborative manner without bias, harassment, or discriminatory conduct. The physician must also ensure that ethical principles are upheld when working in teams.

31. The physician should respect colleagues’ patient-physician relationships and not intervene unless requested by either party or needed to protect the patient from harm. This should not prevent the physician from recommending alternative courses of action considered to be in the patient’s best interests.

32. The physician should report to the appropriate authorities conditions or circumstances which impede the physician or other health professionals from providing care of the highest standards or from upholding the principles of this Code. This includes any form of abuse or violence against physicians and other health personnel, inappropriate working conditions, or other circumstances that produce excessive and sustained levels of stress.

33. The physician must accord due respect to teachers and students.

Duties to society

34. The physician must support fair and equitable provision of health care. This includes addressing inequities in health and care, the determinants of those inequities, as well as violations of the rights of both patients and health professionals.

35. Physicians play an important role in matters relating to health, health education, and health literacy. In fulfilling this responsibility, physicians must be prudent in discussing new discoveries, technologies, or treatments in non-professional, public settings, including social media, and should ensure that their own statements are scientifically accurate and understandable.

Physicians must indicate if their own opinions are contrary to evidence-based scientific information.

36. The physician must support sound medical scientific research in keeping with the WMA Declaration of Helsinki and the WMA Declaration of Taipei.

37. The physician should avoid acting in such a way as to weaken public trust in the medical profession. To maintain that trust, individual physicians must hold themselves and fellow physicians to the highest standards of professional conduct and be prepared to report behaviour that conflicts with the principles of this Code to the appropriate authorities.

38. The physician should share medical knowledge and expertise for the benefit of patients and the advancement of health care, as well as public and global health.

Duties as a member of the medical profession

39. The physician should follow, protect, and promote the ethical principles of this Code. The physician should help prevent national or international ethical, legal, organisational, or regulatory requirements that undermine any of the duties set forth in this Code.

40. The physician should support fellow physicians in upholding the responsibilities set out in this Code and take measures to protect them from undue influence, abuse, exploitation, violence, or oppression.

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