Understanding the Limits of Legal Duty
A recent High Court ruling (Welkovics v Health Professional Council of South Africa (A274/2024) [2025]) has clarified that doctors are not legally or ethically obligated to accept every private patient seeking care particularly where no immediate medical emergency exists.
The case concerned a private patient who was refused treatment by a doctor practicing at a private hospital. Based on the factual circumstances and testimony, the Court found that there was no medical emergency requiring urgent care at the time of the doctor's refusal. Therefore, the decision to not accept the patient under his care did not breach any legal, constitutional, or ethical obligation.
Importantly, the Court emphasised that the doctor-patient relationship and the resulting legal 'duty of care' only arises when a doctor explicitly accepts responsibility for a patient or gives a clear indication of doing so. Merely being approached by a patient or a referring doctor does not in itself establish a legal duty.
In this instance, the doctor explained that accepting the patient would have automatically created such a relationship, obligating him to continue providing treatment regardless of the patient's financial constraints. His concern was not personal financial loss, but rather whether he could continue providing the necessary treatment that the patient could not afford. His refusal was based on the risk of being placed in a position where he had a legal duty towards the patient without adequate financial assurances.
The Court ruled that his decision did not amount to a breach of any legal, constitutional, or ethical duty related to emergency care. This judgment highlights the distinction between moral expectations and legal obligations. Instances of emergency healthcare require that all medical professionals provide care regardless of the patient's financial means or status. However, outside such scenarios, doctors retain the discretion whether to take accept a patient, especially in the private sector.
This decision underscores the importance of understanding when legal and ethical obligations begin and the circumstances under which treatment can be lawfully refused.
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