The Medical Council's executive board yesterday stood by its controversial decision to allow doctors the right to refuse treatment in non-emergency cases. Critics have claimed the move is unfair and aims to simply protect doctors from malpractice lawsuits.

At a news conference yesterday the council rebutted widespread criticism of the move, published in a recent announcement.

"There's nothing legally binding or anything that affects human rights or the rights of patients in this announcement," council president Somsak Lohlekha said.

The controversial directive says doctors can refuse to treat patients whose lives are not in danger. It said that complications in cases where sufficient caution was exercised by doctors should be considered a "force majeure" - an unforeseeable event not preventable by due care.

The council also said medical services suffered from limited facilities, the emotional and physical condition of practitioners and their environment.

Somsak insisted the announcement informed people, the news media and others of the facts about the limits of medical treatment.

"The Medical Council has spent more than four years preparing this announcement. It's for the benefit of patients," Somsak said.

The directive reads "for the benefit of patients medical practitioners may refuse to treat patients who are not in need of immediate treatment and not in a life-threatening condition but must give proper recommendations or make proper referrals".

The council said yesterday doctors were now advised to transfer patients to better-equipped facilities if they were not specialised in a particular illness or procedure. If doctors did this they were protected from negligence claims.

Council secretary-general Dr Pinij Kullawanich said it would continue to inform patients of the news.

Somsak said the full council would tomorrow consider how to deal with growing criticism of the move. "It's possible further explanation will be made to clarify the content of the announcement or wording could be changed to avoid further misinterpretation," he said.

The council noted doctors had been fined and jailed for negligence in cases where patient death or disability resulted, mainly from untreatable existing disease or disability.

In addition, some diseases like dengue fever did not present obvious symptoms in their early stages and, therefore, proper diagnosis was possible only after the onset of symptoms.

However, Rural Doctors Association chairman Kriangsak Wacharanukunkiat suggested the council could remove clauses from the directive about refusal of treatment and protection from unfair litigation.

The council's executive board said yesterday doctors were exhausted and lacked rest because of the government's universal-healthcare scheme. Tired doctors could make mistakes, it said.

The board called on Public Health Minister Mongkol na Songkhla to ensure proper working conditions for doctors or show responsibility.

"Problems can be prevented if the government ensures sufficient medical services. Non-emergency cases should be treated during office hours only," the council said.

Duangkamon    Sajirawattanakul

The Nation