Medical students, resident physicians, and other staff should
refuse to participate in patient care ordered by their supervisors in
cases in which the orders reflect serious errors in clinical or ethical
judgment, or physician impairment, that could result in a threat of
imminent harm to the patient or to others. In these rare cases, the
complainant may refuse to provide the care ordered by the supervisor,
if that will not threaten the patient's immediate welfare. The
complainant should communicate his or her concerns to the physician
issuing the orders and, if necessary, to those mediating such disputes.
Mechanisms for resolving these disputes immediately should be in place.
Third-party mediators of such disputes may include the chief of staff
or the involved service, the chief resident, a designated member of the
institutional grievance committee, or, in large institutions, an
institutional ombudsperson outside of the hospital staff hierarchy.