Abstract
Refusal to help means for most people declining to accept the duty to treat. The reasons for refusing to help and how we think about these reasons from an ethical and professional viewpoint are outlined by considering ethical principles, an historical perspective, the law, societal contracts, medicine as a moral enterprise, professional codes, a physician's personal beliefs, reasons for refusing to help and physician discretion. Refusing to help a patient is not consistent with the ethical principle of beneficence, the concept of the primacy of patient welfare or the obligation of the profession to care for the sick. However duty to treat should not be exploited by institutions or place physicians in circumstances that they consider morally, psychologically or physically unacceptable. Following the principle of distributive justice, physicians are obligated to participate in the public debate to ensure that all patients have their needs met by developing or improving health care systems and addressing the new ethical questions that are likely to be generated.
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