A duty to go to the rescue

If one reads only Maltese newspapers, one obtains the impression that bioethics is mostly related to procreation or lack of it. There is one aspect of medical ethics, which is rarely discussed. This is the duty of presence of a medical practitioner in case of an emergency, which may be that of his/her patient or any other person who feels s/he is in some kind of physical or mental medical crisis.

I have corresponded with a few medical councils regarding this matter. The basic impression I obtained was that any person is duty and legally bound to assist another person in a situation of danger – within reasonable capacity. I cannot, for example, physically stop a hold-up. However, I am in duty bound to help an accident victim by calling for medical help instead of just staring. This duty becomes even stronger if I am a member of the medical profession.

I have considered elements of this nature in some medical ethics literature, including that of the Medical Council of New Zealand, which I believe to be typical of the Anglo-Saxon medical world and beyond. Malta’s official medical ethics regulations include items related to the subject of availability of the medical practitioner in case of emergency. This goes beyond the availability to a regular patient. Section 6 (iv) refers to “gross or prolonged neglect of duties and disregard of personal responsibility to the patients, to clients and to the public”.

New Zealand’s Code of Ethics for the medical profession is subtitled: A doctor’s duty to help in a medical emergency. The introduction states that: If asked to attend a medical emergency… a doctor must respond. This is both an ethical and legal obligation. Rarely there will be times when attending a medical emergency is impossible or unsafe for the doctor or patient. If a doctor chooses not to attend he or she may be required to defend that decision in the event of a charge of professional misconduct or criminal prosecution.

The following sections are directly related to the above:

The Medical Council has adopted the definition of a medical emergency by S. Milesi as “a sudden, unforeseen injury, illness or complication, demanding immediate or early professional care to save life or prevent gross disability, pain or distress. The immediate responsibility of the doctor faced with or called to an emergency is to apply his knowledge and skill to the saving of life and relief of suffering… This is the basic philosophy of medicine...”.

One notes here that “emergency” includes a psychological emergency because it may involve “distress” and “relief of suffering” which, as we know, may be of a psychological nature.

Section 4 states: A doctor is at risk of being professionally or criminally responsible if he or she fails to render prompt and appropriate medical care to any person (whether the patient is a current patient or not) in a medical emergency. A doctor who chooses not to attend must have good reason and be able to defend this position at a later time.

When specific situations make it very difficult for a doctor to attend an emergency, there are alternatives as mentioned in section 6: In all these situations a doctor still has a duty of care to the patient. If unable to attend a medical emergency, the doctor has a duty to make reasonable effort to assist the caller to locate alternative care to ensure that the patient receives appropriate care from another health professional (another practitioner, hospital or ambulance). Failure to attend a medical emergency because it is inconvenient is unacceptable and may result in disciplinary and possibly criminal prosecution. For this reason Council recommends that a doctor keeps a written record of his or her reasons for not attending in case this decision is queried at a later date.

Perhaps the most relevant sentence in the above is “failure to attend a medical emergency because it is inconvenient is unacceptable…”. Thus, a doctor cannot refuse to attend an emergency if he is dining with his wife or relaxing at home etc.

Under sections 151 and 160 of the Crimes Act 1961, everyone who has charge of any other person by reason of sickness has a legal duty to provide the necessaries of life to that person.

If that person’s life is endangered, or health is permanently impaired as a result of a doctor’s failure to fulfill this duty, and there is no lawful excuse, a doctor may be criminally liable and subject to imprisonment for a term not exceeding seven years.

In a nutshell, the conclusion to New Zealand’s code of medical ethics states: The New Zealand Medical Association’s Code of Ethics takes the position that a doctor cannot refuse to care for a patient in an emergency.