Israeli Physicians to be Told They Must Treat HIV Carriers- Haaretz

According to a report by Haaretz, the Israeli Medical Association-(IMA)'s ethics committee has decided that it is unethical for a doctor to refuse to treat a patient with HIV. (For the IMA's statement in Hebrew click here.) I'm not sure why doctors would refuse HIV patients any more than patients with other highly infectious and fatal diseases. The article suggests that it may be due to certain prejudices and a stigma that attaches to HIV patients. Now, this statement by the IMA is not a legal decision so if a doctor would refuse to treat a patient it seems that they would not be violating any law but they might be subject to discipline by the IMA.

This new stance is not so clear to me because the IMA's position, found on its website, is that "A physician must offer medical assistance in urgent cases or in life-saving situations. In any other instance a physician may decide not to provide medical treatment to a patient for personal or professional reasons." So I'm not sure whether this new statement is referring to urgent cases or non-urgent cases. If it is referring to non-urgent cases then it seems to signal a reversal of policy. (In Australia, doctors have a duty to provide care, at least in urgent cases, even where there is no previously existing doctor-patient relationship.)

I posted a few months ago about the law that allows a medical facility to bar violent people from the premises but does not allow the facility to refuse medical treatment of the violent person. But according to the recent statement regarding HIV, perhaps an individual doctor could still refuse to treat a violent patient where the doctor is at risk of injury. 

One way to deal with this issue is to add a clause to the doctor's employment contract prohibiting her from refusing to treat patients unless under certain pre-defined circumstances. But, what if, for example a religious female doctor does not want to treat male patients and the facility makes treating male patients a condition of her employment would she have a case for religious discrimination? There is an interesting piece on the issue of turning away patients in the online journal First Things entitled Can Muslim Doctors Refuse to Treat the Opposite Sex?

This issue touches on the duty to rescue and the law of the Good Samaritan. In many jurisdictions, a bystander has no duty to rescue a stranger in distress. But if there is a special relationship between the parties, such as a lifeguard/swimmer, parent/child or doctor/patient then there typically is a duty. However, the rescuer does not always have to imperil themselves in order to save the person in need. The question at issue involves whether there is, in fact, a risk to doctors to treat HIV infected patients. The head of the ethics committee, according to the article, said that "treating AIDS patients and HIV carriers does not pose an unreasonable risk of infection to doctors who take appropriate precautions."

One health care blog post that discusses the issue of turning away overweight patients says that in the US:

The reason the AMA’s position is that,”…patients and doctors can “exercise freedom in choosing with whom to enter into a patient physician relationship…” is because just becoming a professional doesn’t mean you lose your autonomy. I know doctors who refuse to care for patients who smoke.

Another post on the AMA Ethics website addresses this issue as well and suggests that students contemplating a career in medicine ask themselves whether they can "in good conscience, do the work required of their profession? If the answer is that the work itself creates such an internal conflict, perhaps the student should consider another specialty where such conflict does not readily arise." A recent study found that "74% of respondents felt that by deciding to enter medical school they were morally obliged to treat any patient despite the risks." 

For the Jewish law view of the duty to rescue, see this article by Professor Aaron Kirschenbaum.