Discussion Response – Patient Refusal to Treatment

Discussion Response – Patient Refusal to Treatment

There are some cases where a doctor can override the choices of a patient. When a doctor and a patient are in disagreement over the treatment of a child, the doctor can make a decision based on a clinical judgment when he/she believes the legal, ethical, and medical basis are solid. Additionally, when one parent agrees to treatment while another refuses, the doctor can proceed with the treatment. A patient who refuses treatment for a communicable disease can have the decision nullified by a doctor, and so too can a patient who is mentally ill (Torrey, 2019).

A person who is deemed to be mentally ill cannot make a decision to refuse treatment (Bingham, 2012). However, such a patient must be diagnosed as being mentally unstable to make any such decision regarding their health status. The mental health capacity of the patient needs to be assessed by an experienced healthcare professional or trained expert who is either involved in carrying it out or is recommending the investigation or treatment. If the patient has not appointed anyone to make decisions on their behalf, then the doctor carefully considers what is in the best interest of the patient prior to making a decision (Stirrat et al., 2010). Scheff (2017) proposes that a health practitioner must ensure that the patient is taken care of following a checklist: ensure the condition is diagnosed properly, a professional network for support is established for the patient, relevant information on what to expect and the best way to behave; know the danger signals that the patient elicits and the manner in which to respond. A diagnosis must include a physical exam that will rule out physical causation of the problem; laboratory tests, which will include a thyroid check or drug and alcohol screening; and a psychological evaluation where the patient will be allowed to talk about his/her behavior patterns, feelings, thoughts, and symptoms.

References

Bingham, S. L. (2012). Refusal of treatment and decision-making capacity. Nursing Ethics, 19(1), 167-172.

Scheff, T. J. (2017). Being Mentally Ill: A Sociological Study. Routledge.

Stirrat, G. M., Johnston, C., Gillon, R., & Boyd, K. (2010). Medical ethics and law for doctors of tomorrow: the 1998 Consensus Statement updated. Journal of Medical Ethics, 36(1), 55-60.

Torrey,T. (2019). Do Patients Have the Right to Refuse Medical Treatment? https://www.verywellhealth.com/do-patients-have-the-right-to-refuse-treatment-2614982

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Discussion Response – Patient Refusal to Treatment

Patients Rights to Refusal of Medical Treatment

A patient who is decisional capable has the right to refuse treatment even when it means the procedure will save his/her life. Hence, such a patient’s refusal to accept the recommended surgical or medical intervention ought to be respected (Pozgar, 2019). It is impermissible to use coercion both ethically and medically because of the prognostic uncertainties, realities and medical knowledge limitations. That said, it is unacceptable for physicians to attempt to influence patients in making clinical decisions through coercion. It is critically important to elicit the patient’s lived experience, reasoning, and values when a health practitioner engages with such a patient (Pinals, 2009). Medical expertise can be applied best when the health practitioner strives to gain an understanding of the context within which the decision to refuse medical intervention by the patient is made (Sposato, 2010).

A number of factors need to be considered when seeking to reach a resolution, and these include the evidence base’s validity and reliability; the prospective outcome severity, degree of risk or burden that the patient bears; the extent of the patient’s understanding of the situation’s potential gravity or the involved risk; and the case’s degree of urgency. Ultimately, however, the final decisions rest with the patient and should be upheld (Stirrat et al., 2010).

However, there are three categories of patients who have no legal right to decide for refusal of treatment, even when it is a matter of a life-threatening injury or illness (Torrey, 2019). These categories of patients include those with altered mental status, children, and a person who is a threat to the community. A person with an altered mental status due to psychiatric illness, brain injury, or use of drugs or alcohol cannot refuse treatment. A parent or a guardian to a child cannot refuse treatment that is life-sustaining or denies the child medical care. This includes decisions made on religious beliefs, and thus, a parent cannot invoke religious freedom rights in refusing a child’s treatment. Lastly, a person who has an illness that is a threat to a community cannot refuse treatment or isolation, such as in the case of a communicable disease. A mentally ill person who is a threat to self or others cannot refuse treatment either (Bingham, 2012)

References

Bingham, S. L. (2012). Refusal of treatment and decision-making capacity. Nursing Ethics, 19(1), 167-172.

Pinals, D. A. (2009). Informed consent: Is your patient competent to refuse treatment? Current Psychiatry, 8(4), 33-43.

Pozgar, G. D. (2019). Legal and ethical issues for health professionals. Jones & Bartlett Learning.

Sposato, M. P. (2010). Medical futility. US Army Medical Department Journal, 28-33.

Stirrat, G. M., Johnston, C., Gillon, R., & Boyd, K. (2010). Medical ethics and law for doctors of tomorrow: the 1998 Consensus Statement updated. Journal of Medical Ethics, 36(1), 55-60.

Torrey, T. (2019). Do Patients Have the Right to Refuse Medical Treatment? https://www.verywellhealth.com/do-patients-have-the-right-to-refuse-treatment-2614982

Michelle

RE: Patient’s Rights to Refusal of Medical Treatment

Patients do have the right to refuse treatment for many different reasons. Patients refuse treatments for religious beliefs because they can do certain things according to their beliefs. “Jehovah’s witness cannot receive blood transfusion even if it is life-threatening this can put their families in a hard situation when this can save their life” (Kleinman,1991). Choices must be made for many different reasons, causing outcomes that may not be best for the patients at all times. In these cases, the hospital can only make recommendations as to what is best for the patient, but they have the final say in their own treatment. This can be hard for the doctor when they want to help the patient and their family, but they have no way of going against their beliefs or personal morals.  Do you believe there are some cases where a doctor can override the patients’ choices? if so, why or why not? Who makes the choice that mentally ill patients are not capable of making their own decisions, and what processes must be taken to care for these patients?

References

Kleinman,, I. (1991). The right to refuse treatment: Ethical considerations for the competent patient. CAN MED ASSOC, 1, 1219-1224. Retrieved June 3, 2019.