Can physicians be sued for not treating patients?

Physicians Can Be Sued for Not Treating Patients

Yes, physicians can be sued for not treating patients, particularly when this refusal results in harm to the patient or violates the standard of care. 1 Medical malpractice litigation commonly involves allegations of failure to diagnose and failure to treat, which can lead to significant financial consequences for physicians.

Legal Framework for Treatment Refusal

The legal risk of refusing to treat patients varies based on several key factors:

• Standard of Care Violation: Physicians have a duty to adhere to the prevailing standard of care. Refusing treatment that falls within this standard could constitute malpractice 1

• Established Physician-Patient Relationship: Once a physician-patient relationship exists, physicians have legal obligations to provide appropriate care 1

• Emergency Situations: The risk of liability increases substantially in emergency situations where refusal to treat could lead to immediate harm 1

• Discriminatory Refusal: Refusing treatment based on protected characteristics (race, gender, etc.) violates anti-discrimination laws

Categories of Treatment Refusal

The American Thoracic Society and other medical societies categorize treatment refusals into several types 1:

1. Futile Interventions: Physicians may refuse treatments that cannot accomplish the intended physiological goals (e.g., CPR for a patient with signs of irreversible death)

2. Legally Proscribed Treatments: Physicians can refuse treatments prohibited by law (e.g., physician-assisted suicide in states where illegal) 1

3. Potentially Inappropriate Treatments: Physicians may refuse treatments that have some chance of success but where ethical considerations justify refusal (e.g., ICU admission for end-stage dementia with multiorgan failure)

4. Time-Pressured Situations: In rapidly deteriorating conditions, physicians may refuse treatments they have high certainty are outside accepted practice

Risk Management Strategies

To minimize legal risk when refusing treatment, physicians should:

• Document thoroughly: Clear documentation of clinical reasoning, patient discussions, and decision-making processes is essential 2

• Follow institutional protocols: Use established conflict resolution processes for treatment disagreements 1

• Provide alternatives: Offer appropriate alternative treatments or referrals to other providers 3

• Obtain informed refusal: Ensure patients understand the risks of refusing recommended treatments 4

• Consult ethics committees: Involve institutional ethics committees in complex cases, especially for unrepresented patients 1

Financial Implications of Malpractice Claims

The financial consequences of malpractice litigation can be substantial:

• In stroke care, the average settlement is $1,802,693, and the average plaintiff verdict is $9,705,099 1, 2

• 56% of malpractice cases related to acute stroke management resulted in no payout, 27% were settled out of court, and 17% went to court with a verdict for the plaintiff 1

Special Considerations

Unrepresented Patients

For patients without decision-making capacity or surrogates, physicians face additional challenges:

• These patients are vulnerable to both overtreatment and undertreatment 1
• Fear of civil liability often leads to "maximum medical intervention" even when not clinically warranted 1
• Institutional processes should be established to protect these highly vulnerable patients 1

Potentially Inappropriate Treatment Requests

When patients or families request treatments physicians consider inappropriate:

• Follow established conflict resolution processes 1
• Explain reasons for refusal and explore underlying concerns 1
• Consider second opinions to clarify medical facts 1
• Involve communication experts to facilitate discussions 1

Conclusion

While physicians have the right to refuse providing treatments that deviate from standard clinical practice or are futile/inappropriate, they must follow proper protocols to minimize legal risk. The balance between physician judgment and patient autonomy remains complex, requiring careful navigation of ethical principles and legal requirements.