Life-saving and postponing a patient’s death is a doctor’s main obligation and, undoubtedly, in most cases, the decisions that doctors make definitely make a difference to the outcome of a patient’s condition. Upon graduation, each doctor takes the Hippocratic Oath, which states that a doctor’s role is to practice medicine with honesty, give no deadly medicine, and use their best ability and judgment, when treating a patient, among others. However, there are times when a doctor is unable to help save a patient’s life resulting in the death of the patient. Doctors should not be blamed for failing to save patients’ lives, in cases when a patient fails to follow up, asks for exercise their right to make their own decisions in regards their health, and when the doctor has done everything humanly possible, given the current knowledge and means.
Doctors should not be held responsible for a patient’s death, in the following cases:
Doctors are expected to use their acquired skills and special knowledge towards the best interest of the patient, who has laid all his/her hopes for healing and a cure up to the doctor. Bearing this in mind, the doctor needs to have the patient’s medical record and other necessary information in order to proceed to a surgical operation or decide on treatment (Pandit and Pandit). Although, “a doctor may not be in a position to save his patient's life at all times, he is expected to use his special knowledge and skill in the most appropriate manner keeping in mind the interest of the patient who has entrusted his life to him” (Pandit and Pandit). However, some patients refuse the treatment or surgery that the doctor has determined as the best approach to save their life. A patient’s refusal to treatment or surgery could in some cases, cost them their lives. For example, a study conducted in 2005 found that women with breast cancer that did not follow their surgeon’s advice to undergo surgery, which is considered a main component of curative breast cancer treatment, were twice as likely to die (Verkooijen et al). In such cases, when a patient’s survival is strongly impaired, if the patient refuses surgery and eventually dies, it is, under no circumstances, the doctor’s fault.
Apart from prescribing proper treatment as per each patient’s case, a doctor also gives valuable advice that can help prolong one’s life, and enhance his/her wellbeing. However, if the patient refuses to abide by the doctor’s advice and ends up dying, how can one blame the doctor? For example, when an obese individual shows up in a doctor’s office with arrhythmia and the doctor recommends loss of weight and a specific turn in the patient’s lifestyle, which alongside proper medication will help to save the patient’s life and prevent them from further health complications, the patient needs to adhere to the doctor’s orders. According to the Standards of Practice, as published by the College of Physicians and Surgeons of Alberta (2010), a doctor is now allowed to discharge a patient based on the grounds that the patient fails to follow medical advice (16). However, in cases when “the patient is repeatedly non-adherent despite reasonable attempts by the physician to address the non-adherence” (College of Physicians and Surgeons of Alberta 16), the doctor can withdraw from treating the patient.
In any other case, the doctor cannot force any patient to follow up. Undoubtedly, free will is a patient’s right. Therefore, consequences should burden only the patient that has chosen not to follow the doctor’s advice.
Some family members of a deceased patient blame the doctors that were in charge of treating their loved one for his/her death, some years after the patient has deceased. History has shown that the medical field is continuously evolving, and new practices, interventions, medication, and cures come to light, and help heal diseases that were once perceived as incurable. For example, malaria and the measles were considered deadly diseases and people were dying by the thousands. Nobody can put the blame on the doctors of the 1900s for not curing patients with our modern interventions and latest vaccination. In such cases, the doctors have only applied the best of the knowledge of their time, which is what their role is all about.
Unfortunately, current legislation and reform programs tie the hands of doctors, when a patient with no insurance or insufficient insurance requires medical help. It is a serious moral dilemma that most doctors go through. To many, it is an ethical obligation to provide patients with proper medical care, regardless of the fact that patients do not have either the resources or health insurance to pay for their treatment. These feelings are more intense in the field of oncology. According to The American Medical Association Code of Medical Ethics, physicians are encouraged to dedicate some of their time, in order to help patients that are unable to pay for their medical care (Jepson, Cox, and Peppercorn). However, no matter how much doctors may be willing to volunteer some portion of their time, it is highly unlikely they could afford to pay for the cost of the drug therapies of their patients. For example, in cancer care the annual economic factors, including “the high overhead costs associated with owning and running a practice, costs associated with participation in clinical trials, lean reimbursement rates, and low collection rates for uninsured patients” (Jepson, Cox, and Peppercorn) put oncologists under serious thoughts and dilemmas when trying to provide care for the uninsured patients. Sadly, people die, but, if someone is to blame, it is not the doctors. They do whatever humanly possible to help treat a patient, however, they are not Gods, nor legislators.
Although doctors are often called to meet the patient’s request for procedures that the doctor considers morally wrong, some choose to abide by their patient’s wishes. Preserving a patient’s good health is the master role of a doctor, but, in cases of deadly and irreversible health conditions, things change. In such cases, it is the doctor’s morals against his duty to heal and treat patients. For example, when a patient with a deadly illness asks for physician assisted suicide because they want to choose how they die and do not want to live a life in misery and pain, waiting for death to come, the doctor is in-between two contradictory viewpoints. However, when doctors do decide to help their patient, and perform assisted suicide, it cannot be considered a doctor’s fault for letting (and assisting) the patient to die. The right to euthanasia, no matter how controversial, remains a patient’s right to many physicians.
On the other hand, people believe doctors should answer to a court house, in case of:
When patients die, family members and the social cycle of the deceased usually blame the doctor for medical negligence. To them, there is always something more that the doctor should (or could) have done, which may have saved their loved one’s life. Wishful thinking one might say, because if all is done as supposed, doctors cannot play the role of a God. Other than that, medical negligence could be defined as the actions taken by a doctor that result in a patient’s damage of health. In many cases, such as the case of A.S.Mittal v. State of U.P., AIR 1989 SC 1570 (Pandit and Pandit), the court has decided that a doctors has a threefold of duties, which are (1) to determine whether he/she would undertake the case; (2) to decide on proper treatment, after having consulted with the patient; and (3) to administer the chosen treatment properly.
Any breach in the mentioned threefold is considered an action of negligence that could damage the patient’s health (Pandit and Pandit). The first duty of a healthcare provider, as presented in the above list, means that doctors have the right of conscientious refusal. This is usually based on ethical and moral grounds, such as cases related to contraception, sterilization, end-of-life measures, and abortion, among others (Pope). It is still debatable how a doctor is to be blamed for any loss of life, in cases when his/her ethics stand in the way. As for deciding on proper treatment, treatments may have unwanted and unpredictable results that a doctor could not have known. Drugs are retrieved from the market from time to time, due to complications. Finally, if a patient dies because their medication was not administered properly, it is not the doctor who had prescribed the medication who should take the blame, but the nurse’s (if treated in hospital or clinic), or the person that is responsible for taking care of the patient at home, or other premises.
Doctors are healthcare providers whose role is to help save people’s lives from serious health conditions, illnesses and injuries and preserve their health. No doctor would ever want a patient of theirs to die; however, people do die of various reasons that cannot be attributed to the doctor that has been treating the patient. There are cases when patients refuse treatment or surgery that is perceived as life-saving for them. There are also cases of terminally ill patients that ask their doctor to help them end their life, so to escape the misery and pain and die with dignity. Morals and ethics get in the way, in more cases than one, and doctors are called to make decisions for the best interest of their patients. However, if a patients does not to follow up doctors’ orders, or chooses not to live, and eventually dies, doctors should not be blamed for it.
Jepson, Victoria, Cox, John and Peppercorn, Jeffrey (2010). “Ethical Challenges: Oncologists' Role in Immigrant Health Care”. Journal of Oncology Practice. doi: 10.1200/JOP.000129 JOP September 2010 vol. 6 no. 5 247-248
Pandit, M.S., and Pandit, Shobha (2009). “Medical negligence: Coverage of the profession, duties, ethics, case law, and enlightened defense - A legal perspective”. Indian J Urol. 2009 Jul-Sep; 25(3): 372–378. doi: 10.4103/0970-1591.56206. PMCID: PMC2779963.
Pope, T.M (2010). “Legal briefing: conscience clauses and conscientious refusal”. Journal of Clinical Ethics. 2010 Summer;21(2):163-76. PMID:20866024.
Verkooijen, Helena et al. (2005). “Patients’ Refusal of Surgery Strongly Impairs Breast Cancer Survival”. Ann Surg. Aug 2005; 242(2): 276–280. doi: 10.1097/01.sla.0000171305.31703.84. PMCID: PMC1357734