In response to questions raised by physicians around the state, the Texas Medical Association Office of General Counsel and the TMA COVID-19 Task Force have drafted a new white paper and a letter addressing physicians’ legal and ethical responsibilities to patients.
The “Legal Pitfalls of Patient Termination” white paper is a detailed document that physicians may find useful in numerous situations.
“The patient-physician relationship is the result of a contract between a physician and a patient that the doctor will treat the patient with proper professional skill,” the white paper states. “Although the relationship is contract-based, the contract need not be formal — it can be implied, which means the acts and conduct of the parties demonstrated there was a mutual intention to contract. When that relationship becomes untenable for either party, dissolution of the relationship may become necessary.”
The white paper provides answers to these critical questions:
- May a physician terminate his or her relationship with a patient for any reason?
- May a physician lawfully terminate his or her relationship with a patient at any time?
- How should notice be given to the patient?
- How much notice is required?
- What other considerations are relevant in composing the notification letter to the patient?
- I lost contact with a patient I treated several years ago. If the patient calls for an appointment, am I still obligated to see the patient?
- A patient of mine left the hospital “against medical advice.” Later the patient wants to make an appointment with my office. Am I obliged to treat the patient?
- I need to terminate my relationship with a managed care patient. What considerations apply?
- Suppose I treat a patient in the emergency department, and that patient needs to be transferred to another hospital. Another hospital and treating physician are found, and the patient is loaded into the ambulance for transport. Am I discharged from that patient’s care when the patient leaves the hospital?
The white paper also includes a sample letter for use in terminating the patient-physician relationship.
In the document “Medical Ethics During Pandemics: Issues of Duty, Safety, and Non-Abandonment,” the COVID-19 Task Force addresses some of those same questions, specifically in light of the global pandemic.
“What is the physician’s duty when treating the individual patient exposes the physician to personal danger? Should physicians educate ourselves and others, speak truth to power and willful ignorance, and engage with political and business leaders to promote public health measures to stop disease spread?”
The document provides insight into both of these questions, based on the American Medical Association Code of Medical Ethics Opinion on Physician Duty to Treat.
“Questions of ‘duty’ and whether or not actions ‘should’ be taken by medical professionals are fundamentally questions of medical ethics – questions of right and wrong, good or bad about the goals of medicine and the means used to reach those goals,” the task force wrote.
Stay up to date with the latest news, resources, and government guidance on the coronavirus outbreak by visiting TMA’s COVID-19 Resource Center regularly.