Under the traditional common law, physicians and patients entered into
voluntary contracts for services. Patients could choose their own physicians,
and physicians were free to refuse to treat patients for any reason they chose.
This right to refuse to treat was substantially limited by the Civil Rights laws in
the 1960s. Medical care practitioners and institutions could no longer refuse to
treat based on race, religion, or ethnicity. Subsequent to the Civil Rights Act,
the government further limited physicians’ right to refuse to treat in the
Americans with Disabilities Act (ADA) and the Emergency Medical Treatment
and Active Labor Act (EMTALA). However, the greatest change in the freedom
of physicians and patients to contract for medical care has been brought about
by private health plans, not statutes. As private insurance plans have moved to
the MCO model, they have limited both the physician’s right to refuse to treat
and the patient’s right to choose his or her physician.