Medical Abandonment

The issue of patient abandonment versus health care professional’s rights, is a basis for heated argument, ethical discussions and litigation. It is a question of balance between patient needs and the personal rights of those involved with health care delivery. Once the doctor or other health professional accepts the treatment of a patient he has accepted a “duty of care.” He cannot walk away from that duty. To do so, just like walking away from your wife or child, is abandonment. As such, the doctor, nurse or other therapist is liable to punishment by their professional body and liable for civil action if the patient has sustained a loss.

Some would even go so far as to suggest that absence of physical support is not the only type of abandonment, and that psychological abandonment involves treating a patient in a such a manner that the patient becomes a total non-person to the health professional. Whether a particular situation is abandonment is not always as clear as black and white.

Abandonment is further defined as termination of the caregiver-patient relationship without making reasonable arrangements with an appropriate person to continue needed care. A doctor is allowed to go on holiday, but when he does, arrangements for the care of his patients must be made. A surgeon must make arrangements for the care of his patients in the hospital if he goes off for the week-end or to a conference.

If a claim of abandonment is made, factors to be considered would include:

Was there a duty of care?

Had the caregiver accepted the patient assignment?

Did the caregiver provide reasonable notice before terminating the caregiver-patient   relationship?

Could reasonable arrangements have been made for the continuation of care by others when proper notification was given?

Was the reason for terminating the arrangement because of the doctor’s selfish interests, or was it because another person had greater need of his services?

A distinction is made between Intentional abandonment and Inadvertent abandonment, the latter due to misunderstandings over scheduling  of back-up coverage for persons working in institutions. Constructive abandonment might be claimed against a physician who left his patient anticipating another would come on call and accept responsibility, but that person did not do so, the claim is against the first and not the second doctor.

Refusing to accept the care of a patient when there was no obligation to do so, and when no emergency dictated the need, would probably not be considered abandonment and is supported by the American Medical Association’s Principles of Medical Ethics, A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical services. There has long been, in the United States, a reluctance to force one person to provide services to another against their will.

(Probably) legitimate reasons to discontinue care

a) When treatment needs exceed the ability and expertise of a health care professional, the patient is best served by having care transferred to a more qualified practitioner.

b) It is commonly agreed that a health care practitioner may withdraw from the care of a patient who acts inappropriately within the health care setting. The most common situation discussed is when a patient becomes violent or acts in ways that endanger the practitioner, other patients, or staff.

c) The Comprehensive Accreditation Manual for Hospitals emphasizes that to respect all staff members, a health care institution (or practice) should establish policies for how staff members can make requests to discontinue care for ethical, religious, and cultural reasons. For instance, a Roman Catholic anesthesiolgist should not be obliged to assist at an elective abortion.

Problem Areas

a) The non-compliant patient? What if that patient is extremely non-compliant versus occasionally non-compliant?

b) The patient who does not pay his bills? Is refusing to treat such a patient justifiable? This is said to be one of the commonest reasons for abandonment, and also the least easy to justify to a jury.

c) The especially demanding patient. If a patient takes time away from the care of others, and continually calls the practitioner beyond normal care hours, is withdrawal from the care of such a patient acceptable?

d) The patient whose appearance or manners disgusted a practitioner. If a practitioner is so put off by a patient that it impedes his ability to be an effective therapist, would withdrawing from the case be an act of abandonment or patient benefit?