Can a doctor refuse a patient? The duty to treat
- Topic
In an emergency a doctor must always treat; outside one, a doctor may withdraw only for the reasons the law lists and without leaving the patient without care.
What it is
The duty to treat comes from beneficence and justice: medicine exists for whoever needs it. In Colombia, Law 23 of 1981 says the doctor shall provide the benefits of medicine to every person who needs them, with no limits other than those of the law itself (art. 3). Those limits are few. The doctor must refuse acts contrary to morality, or care given under conditions that prevent sound practice (art. 6). Outside an emergency the doctor may decline or stop care only if the case is outside the doctor's specialty, if another professional is treating the patient in a way that excludes them, or if the patient refuses the instructions (art. 7). In an emergency there is no excuse: care is not conditional on payment (art. 23), Law 100 of 1993 obliges every institution to give initial emergency care with no contract or prior order (art. 168), and Statutory Law 1751 of 2015 forbids requiring administrative authorisation for it (art. 14). None of these reasons allows refusal on grounds of discrimination, the chronic nature of the disease or who the patient is. Conscientious objection is a separate matter with its own rules.
Key facts
- Law 23 of 1981, art. 3: treat every person who needs it, with no limits other than those expressly set out in the law.
- Law 23, art. 5, item 2: the doctor-patient relationship also arises from the doctor's unilateral action in an emergency.
- Law 23, art. 7, and Decree 780 of 2016, art. 2.7.2.2.1.1.4: outside an emergency, withdrawal only if the case is outside the specialty (after a general examination), if another professional excludes the doctor without consent, or if the patient refuses the instructions (including tests, case conferences and consultations).
- Decree 780, art. 2.7.2.2.1.1.3 (Decree 3380 of 1981, art. 3): an emergency is any condition that endangers life or bodily integrity and needs immediate care in the doctor's judgement.
- Law 23, art. 17: chronic or incurable disease is no reason to deprive a patient of care.
- Law 23, art. 23, and Law 1751 of 2015, art. 10(b): emergency care requires no prior payment or document.
- Law 1751 of 2015, art. 14: emergency care needs no administrative authorisation between the provider and the entity that manages services.
- Law 100 of 1993, art. 168: every public or private provider must give initial emergency care to all people, with no contract or prior order.
In clinical practice
- A patient arrives at the emergency department with no active insurance or ID: care comes first; the paperwork comes later.
- An outpatient repeatedly refuses essential tests: the doctor may end the relationship (art. 7(c)) but explains why, records it and helps another professional take over.
- An orthopaedic surgeon sees a patient with a disease outside the field: a general examination, withdrawal on grounds of specialty and a referral; never a dismissal without guidance.
- Refusing a patient because of HIV status, origin, sexual orientation or migrant status is not a legal ground for withdrawal; it is discrimination.
- The risk to the doctor (violence, lack of protection) is real: the World Medical Association asks doctors to help in emergencies while weighing their own safety and competence, and to seek the conditions to provide care.
Legal framework in Colombia
- Law 23 of 1981, arts. 3, 5, 6, 7, 17 and 23; regulated by Decree 3380 of 1981, arts. 3 to 5, compiled in Decree 780 of 2016 (arts. 2.7.2.2.1.1.3 to 2.7.2.2.1.1.5).
- Statutory Law 1751 of 2015, art. 10(b) (emergencies without prior payment) and art. 14 (no administrative authorisation; art. 14 was reviewed in Ruling C-313 of 2014).
- Law 100 of 1993, art. 168: mandatory initial emergency care.
- Official texts verified on 2026-11-13 on funcionpublica.gov.co and minsalud.gov.co.
Test yourself
Think of the answer, then tap the question to see it.
When may a Colombian doctor decline to treat a patient outside an emergency?
If the case is outside the doctor's specialty, if the patient is being treated by another professional in a way that excludes them, or if the patient refuses to follow the instructions (Law 23 of 1981, art. 7).
Does the institution need the insurer's authorisation to treat an emergency?
No. Law 1751 of 2015 (art. 14) says emergency care requires no administrative authorisation between the provider and the insurer.
May a doctor stop treating a patient because the disease is incurable?
No. Chronic or incurable disease is no reason to deprive the patient of care (Law 23, art. 17); the goals of care change, not the duty to care.
What should a doctor do who decides to end the relationship with a patient who refuses instructions?
Explain the reason, record it in the medical record and help another professional continue the care; never in an emergency.
Connections
Educational content on ethics and health law; not legal advice. Laws and case law change: each page links the official text and says when it was last checked. For a real case, read the text in force and ask a lawyer or the medical ethics tribunal.
Sources: Ley 23 de 1981, arts. 3 to 7, 17 and 23 (Función Pública, Gestor Normativo, 1981); Ley Estatutaria 1751 de 2015, arts. 10 and 14 (Función Pública, Gestor Normativo, 2015); Ley 100 de 1993, art. 168: initial emergency care (Función Pública, Gestor Normativo, 1993); Decreto 780 de 2016, arts. 2.7.2.2.1.1.3 to 2.7.2.2.1.1.5 (compile Decree 3380 of 1981) (Ministerio de Salud y Protección Social, 2016); WMA International Code of Medical Ethics (2022), paras. 2, 9 and 20 (World Medical Association, 2022).
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