Legal risks and responsibilities of physicians in the AIDS epidemic.

Legal Risks and Responsibilities of Physicians in the AIDS Epidemic The refusal of some physicians to care for AIDS patients has been met with general condemnation. Surgeon General C. Everett Koop, for example, has labeled them a "fearful and irrational minority" who are guilty of "unprofessional conduct" that "threatens the very fabric of health care in this country." [1] And a pointed editorial in the New York Times insisted that physicians who think their responsibility to themselves is greater than to their patients "need a new profession." [2] But it is one thing verbally to label such behavior inappropriate, reprehensible, or unprofessional; it is quite another to do something about it. The issue of proper treatment for AIDS and HIV-infected patients should be primarily addressed by the ethics of the medical profession. It is, after all, medical practitioners who have the primary right and obligation to define the standards of their profession. However, should the profession fail to respond adequately to the needs of patients in an unprecedented epidemic, the law will rightfully continue to set a standard of minimum conduct below which no physician may fall without confronting the possibility of losing a malpractice or discrimination suit or even his license to practice. This article's primary concern is to summarize the existing law relating to physicians' obligations to care for AIDS, ARC, and HIV-infected patients. Secondarily, it identifies ways that current law can be strengthened to define more sharply physicians' obligations, so that this population of patients will be assured of continued access to the medical care they need and have a right to obtain. Although this analysis deals with physicians' responsibilities, it is likely that similar legal principles will be used to judge the conduct of dentists, optometrists, nurses, physician assistants, and other allied health professionals. Legal Obligations to Treat American common law is firmly grounded on notions of individual liberty and economic freedom that support the proposition that absent some special relationship, no citizen owes any other citizen anything. As applied to the practice of medicine, the general rule, sometimes denoted the "no duty rule," is that a physician is not obligated to treat any particular patient in the absence of a consensual doctor-patient relationship. [3] In the absence of a prior agreement or a statutory or regulatory prohibition, physicians (like other citizens) can, in deciding whether to accept patients, discriminate among them on the basis of all sorts of irrelevant and invidious criteria; from race to religion, to personal appearance and wealth, or by specific disease, like AIDS. Over the years, there has been some erosion in the "no duty rule" in both common law and statutory law. Courts have affirmed both a duty to treat in limited emergency situations, and the continuing obligation of physicians once a consensual doctor-patient relationship is established. Statutes have been primarily directed toward articulating antidiscrimination principles. In addition, physicians may accept certain obligations to whole groups of patients by contract, such as employment contracts with hospitals and prepaid health plans (HMOs, for example) and agreements related to reimbursement by Medicare and Medicaid. The Emergency Treatment Rule Physicians working in emergency rooms must treat all patients who arrive with a medical emergency. Virtually every modern court has repudiated the ancient doctrine that an emergency room physician need treat only those patients the physician or hospital chooses. The relevant issue is not whether the person can pay, what color the person's skin is, or even if the person has reached the age of consent; the only legally relevant issue is whether the person is experiencing a medical emergency. If so, the individual has a legal right to be treated, and physicians, nurses, and others working in the emergency room have a legal obligation to provide this treatment. …