Can a doctor refuse to treat a patient in India? Regulations 2.1.1, 2.4 and 7.15, the Katara judgment, and what a clinic may and may not say no to.

A doctor in India may decline a patient who is not an emergency, provided the refusal has a good reason and is not arbitrary; the regulations name one such reason, an ailment outside the doctor's range of experience, and expect a referral with it. In an emergency the answer is different: regulation 2.1.1 of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 says "in case of emergency a physician must treat the patient", and the Supreme Court in Pt. Parmanand Katara v. Union of India (28 August 1989) called the obligation to protect life "total, absolute and paramount". What a small OPD does when an emergency arrives is covered in our post on the emergency patient at an OPD. This post is about the rest.

What do the regulations actually say about refusing?

Two clauses, read together. Regulation 2.1.1 opens: "Though a physician is not bound to treat each and every person asking his services, he should not only be ever ready to respond to the calls of the sick and the injured..." It goes on: "A physician advising a patient to seek service of another physician is acceptable, however, in case of emergency a physician must treat the patient. No physician shall arbitrarily refuse treatment to a patient. However for good reason, when a patient is suffering from an ailment which is not within the range of experience of the treating physician, the physician may refuse treatment and refer the patient to another physician."

Regulation 2.4, headed "The Patient must not be neglected", says: "A physician is free to choose whom he will serve. He should, however, respond to any request for his assistance in an emergency. Once having undertaken a case, the physician should not neglect the patient, nor should he withdraw from the case without giving adequate notice to the patient and his family." It adds that a registered practitioner "shall not willfully commit an act of negligence that may deprive his patient or patients from necessary medical care".

What counts as a good reason to decline?

The only reason the regulations spell out is competence: the ailment "is not within the range of experience of the treating physician". A general practitioner asked to manage something that needs a specialist, or a dentist asked about a skin condition, is the case the clause was written for, and the clause pairs the refusal with a referral. Regulation 2.1.1 also says that advising a patient "to seek service of another physician is acceptable".

Beyond that the text does not list reasons, so it does not tell you whether a full day's list, closing time or a patient's past behaviour is a good reason. What it does fix is the test: the refusal must not be arbitrary, it must never apply to an emergency, and it should leave the patient knowing where to go. A doctor who declines should be able to state the reason in one line and point to someone who can help.

Which reasons are not allowed?

Three are written down. First, an emergency, whatever the circumstances; the Katara judgment records an official decision that in a medico-legal case "the treatment of the patient would not wait for the arrival of the Police or completing the legal formalities". Second, under regulation 7.15, a practitioner "shall not refuse on religious grounds alone to give assistance in or conduct of sterility, birth control, circumcision and medical termination of Pregnancy when there is medical indication, unless the medical practitioner feels himself/herself incompetent to do so". Third, discrimination: the Charter of Patients' Rights prepared for adoption by the National Human Rights Commission says every patient "has the right to receive treatment without any discrimination based on his or her illnesses or conditions, including HIV status or other health condition, religion, caste, ethnicity, gender, age, sexual orientation, linguistic or geographical /social origins".

Money sits in between. For emergencies the charter says care "must be initiated without demanding payment / advance". For routine visits, regulation 1.8 says a physician "should announce his fees before rendering service and not after the operation or treatment is under way", which is the clinic's protection: a fee shown at the desk before the consultation is the fee. Our post on signboard and fee display rules covers how to show it.

Can a doctor stop treating a patient who is already under care?

Yes, with notice. Regulation 2.4 does not forbid withdrawal; it forbids withdrawal "without giving adequate notice to the patient and his family", and it forbids neglect while the case is yours. The regulations do not define adequate notice in days. The older Code of Medical Ethics, quoted in the Katara judgment, put it as notice "sufficiently long in advance of his withdrawal to allow them to secure another medical attendant", and that is a fair working test. In practice it means the patient hears it from the doctor, has time to find another doctor, and leaves with what the next doctor needs.

1. Tell the patient, and the family where the patient depends on them, that you will not continue, and why, in plain words.
2. Give a reasonable period during which you will still see them, especially if treatment is under way.
3. Name another doctor or facility who can take over, or a type of specialist if you cannot name one.
4. Hand over a summary of the case and copies of the records they ask for. Regulation 1.3.2 asks for records requested by the patient to be issued within 72 hours; see our post on patient requests for medical records.
5. Write a note in the record: the date, what was said, the referral given, and the documents handed over.

What did the Supreme Court say in Parmanand Katara?

The case grew out of injured people being turned away pending police formalities. The Court held that "every doctor whether at a Government hospital or otherwise has the professional obligation to extend his services with due expertise for protecting life", and that the obligation is "total, absolute and paramount". The Medical Council of India's affidavit, quoted in the judgment, said the council "expects that all medical practitioners must attend to sick and injured immediately". The Court directed wide publicity of the judgment and ended: "Until altered, this judgment shall be followed." It is about the duty to protect life; it does not oblige a doctor to take on every routine patient.

What should the front desk be told?

Refusal is the doctor's decision, never the receptionist's. At most clinics the refusals that cause trouble happen at the counter: "doctor is not seeing new patients", "come tomorrow", "this is not the right clinic", said to someone who turns out to be very unwell. Give the desk three rules: anyone who looks seriously ill or injured goes to the doctor at once; any other turn-away is checked with the doctor first; and the patient leaves with a name or place to go next. If the clinic has a complaints register, log disputes there; our post on patient complaints and feedback covers one.