Most medical care practitioners today have signed contracts obligating
themselves to care for various patients who are insured with a contracting
third-party payer. It is unusual for these contracts to exempt the medical care
practitioner from providing care that is morally abhorrent to him or her.
Without such a specific exemption, it is arguable that the medical care
practitioner is contractually obligated to provide all medically acceptable care
that the patient requests.
Medical care practitioners who work in emergency rooms or in locum tenens
situations are also subject to a contractual obligation to provide all care that is
not specifically exempted from the contract. Even if the medical care
practitioner 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 medical care practitioner 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 must provide 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.