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NMC Proposes Refusal of Treatment by Doctors in Cases of Abusive, Unruly, Violent patients or Relatives

Dec 29, 2022

  • A report found that approximately 75% of doctors face violence, mostly abuse, at some point in their professional life, with ICU and emergency the prime venue and visiting hours
  • The draft proposal from National Medical Commission [NMC] included a section granting doctors the power to refuse treatment in case of unruly, violent patients or their relatives.
  • The section draws criticism from experts on various grounds and is written to the national Medical Commission regarding their concern regarding the proposed section.

Draft National Medical Commission Registered Medical Practitioner (Professional Conduct) Regulations, 2022

To curb the violence against doctors, the National Medical Commission proposes that the doctors may refuse to treat patients if the patients or their relatives are violent or abusive. The proposal is a part of the new Draft National Medical Commission Registered Medical Practitioner (Professional Conduct) Regulations, 2022. However, the draft also advises that the doctor should refer the patients for treatment to other doctors. The proposed section 26 has invited mixed reactions from the experts. If enforced, the proposed regulations would override the Medical Council (Professional Conduct, Etiquette, and Ethics) Regulations, 2022.

Section 26 of draft regulations, 2022

Section 26 in the draft proposal states,  " A RMP is free to choose whom he will serve, except in case of a life-threatening emergency. Having accepted a case, the RMP should neither neglect the patient nor withdraw from the case without giving adequate notice to the patient and his family. If a change of RMP is needed (for example, the patient needs a procedure done by another RMP), consent should be obtained from the patient himself or the guardian. The RMP who attends to the patient will be fully accountable for his actions and entitled to the appropriate fees. In case of abusive, unruly, and violent patients or relatives, the RMP can document and report the behavior and refuse to treat the patient. Such patients should be referred for further treatment elsewhere.”

Potential advantages of Section 26

Some of the advantages that section 26 may have are:

  • Reduced violence against doctors: The new regulation may play a role in reducing the violence against doctors. It will allow the doctors to work more efficiently without fear. If the doctor finds the behaviour of the patient or relative inappropriate, he may have the right to refuse treatment and refer the patient to other doctors.
  • Right to choose patients: Section 26 also gives the right to the registered medical practitioner to choose their patients. However, it will not apply in case of medical emergencies. Thus, the doctor without expertise in a certain therapeutic area may refer the patient to another doctor.
  • Improved transparency: Section 26 may also help improve transparency between patients and doctors. The doctors need permission from the patient or relatives before transferring the case to another doctor. Further, once taken a case, the doctor cannot neglect or withdraw the treatment without giving notice.

Potential disadvantages of Section 26

The experts have criticized proposed section 26 on various grounds. Some of the grounds include:

  • Personal understanding of abusive behaviour: The "abusive, unruly, and violent behaviour" is subjective to the understanding of the individual doctors. Thus, it may lead to increased issues between the doctors and patients. It is also important to understand that the relatives of the patients, especially when the patient is a child, are under severe emotional, financial, and physical stress that may lead to inadvertently unruly behaviour.
  • Against constitutional rights: Some experts believe that while it is necessary to take steps to prevent violence against doctors, section 26 is against the right to life guaranteed under Article 21 of the Constitution. Doctors, being the health guardians of society, cannot deny treatment to any patient.
  • Existing law already strict: The law had already been made stricter. After the protest of doctors in 2019, the Government passed the Epidemic Diseases (Amendment) Act in 2020 that made violence against healthcare professionals a cognizable and non-bailable offence.

Reference

  1. Ghosh K. Violence against doctors: A wake-up call. Indian J Med Res. 2018;148(2):130-133. doi:10.4103/ijmr.IJMR_1299_17
  2. New NMC rule allows docs to deny treatment to patients with ‘abusive’ kin. Avaialbe at: https://thefederal.com/news/new-nmc-rule-allows-docs-to-deny-treatment-to-patients-with-abusive-kin/

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