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Contractual Limitations on Refusing to Provide Care

Most physicians today have signed contracts obligating themselves to care for various patients who are insured with the contracting third-party payer. It is unusual for these contracts to exempt the physician from providing care that is morally abhorrent him or her. Without such a specific exemption, it is arguable that the physician is contractually obligated to provide all medically acceptable care that the patient requests.

Physicians who work in emergency rooms or in locum tenans situations are also subject to a contractual obligation to provide all care that is not specifically exempted from the contract. Even if the physician has a contract that allows certain care to be avoided, a patient seeking care at the emergency room has the expectation that any appropriate care will be available. If there is a threat of immediate danger to the patient or there has been no provision for an alternative source of care for patients in an ambulatory care practice, the physician will have to provide the necessary care without regard for his or her personal beliefs. Even religious hospitals are constrained in the care that they can deny to emergency patients if the denial of care would result in preventable injury. A patient who presented in shock from an incomplete abortion should have an immediate uterine evacuation. It is an unacceptable standard of care to wait to see if the fetal heart had ceased to beat.

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