Expert physicians who reviewed the case believed the FP had appropriately informed the patient about the risks of refusing additional work-up by a specialist and that the patient had made an informed refusal decision. The case was ultimately dismissed. This is another example of a situation involving tension between autonomy and beneficence.
In the current case, the patient out-and-out refused care while, in the other case, the patient influenced the physician to modify his recommendation for hospitalization and convinced him to treat her as an outpatient. The cases are also similar in that good, objective documentation by the physician gave a sufficiently clear picture of what happened and allowed the malpractice allegations to be dismissed. Competent patients have a right to refuse treatment.
This concept is supported not only by the ethical principle of autonomy but also by U. He fully explained his understanding of the situation, the benefits of obtaining assessment and treatment and the risks of refusal. Mahowald MB. Bioethics and Women: Across the Life Span. Fast Facts can only be copied and distributed for non-commercial, educational purposes. If you adapt or distribute a Fast Fact, let us know!
Disclaimer: Fast Facts and Concepts provide educational information for health care professionals. This information is not medical advice. Fast Facts are not continually updated, and new safety information may emerge after a Fast Fact is published. Health care providers should always exercise their own independent clinical judgment and consult other relevant and up-to-date experts and resources.
You have probably made this choice without even realizing it. Maybe you didn't fill a prescription, chose not to get a flu shot , or decided to stop using crutches after you sprained an ankle. You may also be tempted to refuse treatment for more emotional reasons. There is nothing illegal about choosing to forgo treatment for any of those reasons. They are personal choices, even if they aren't always wise choices. Choosing to refuse treatment at the end of life addresses life-extending or life-saving treatment.
When you choose not to be treated, knowing that the refusal will shorten your life, it is usually because you are choosing what you believe will be a better quality of life, rather than a longer life that may be less pleasant.
Some people, knowing they are going to die soon, even choose to end their own lives rather than be faced with decisions that will, in reality, be executed by others. Be aware that if you choose not to receive life-sustaining treatment, it does not mean you are required to forfeit palliative care, which can be administered even for patients who do not want to be kept alive.
Palliative care focuses on relieving pain at the end of life but does not help extend life. Before you decide against receiving treatment at the end of your life, be sure you've followed steps to help you to make that informed decision. You might also consider refusing treatment if you have been diagnosed with a medical problem that requires very expensive treatment.
You may prefer not to spend so much money. Patients make this decision when they believe treatment is beyond their means. They decide to forgo treatment instead of draining their bank accounts. Those who live in a country with a for-profit healthcare system may be forced to choose between their financial health and their physical health. Americans can refuse treatment when they know it will have a negative impact on their finances.
Jehovah's Witnesses and Christian Scientists, plus a few non-affiliated churches in different parts of the United States, may be willing to undergo some forms of treatment, but restrict or refuse other forms based on their religious beliefs. Adults may rely on their church affiliation and its tenets to refuse treatment for themselves if they choose. However, they have less legal standing when it comes to making those choices for their children.
Several court cases regarding children with different diseases and medical needs have addressed the legality of refusing treatment based on religious reasons with varying outcomes.
Take these steps if you are trying to make a refusal decision:. The best way for a patient to indicate the right to refuse treatment is to have an advance directive, also known as a living will. Most patients who have had any treatments at a hospital have an advance directive or living will.
This document is kept on file and tells the treatment team the wishes of the patient in the event that they are unable to speak for themselves regarding their medical care. Another way for a patient's wishes to be honored is for the patient to have a medical power of attorney. This designates a person to make decisions on behalf of the patient in the event they are mentally incompetent or incapable of making the decision for themselves. Involve Family Members and Caregivers Involving family members and other loved ones in the conversation can help get everyone on the same page and avoid divisiveness, says Lopez, which can help improve the outcome, no matter what the patient decides.
Practices will need to show that they have followed protocol to the furthest extent possible—and the reasons for any deviation from the standard of care.
In addition, practices should have patients fill out an informed refusal form, but the form alone is not sufficient documentation.
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