The ethics of a patient refusal of treatment
Given a situation where a patient refuses a novel treatment procedure, or medication that is very essential for his treatment, would it be in the best interests of health care practitioner to force a patient to accept medication or a treatment procedure?
The ethics manual of the American college of physicians defines the primary commitment of the Health care practitioner to the patient as the best welfare of patients. However, sometimes patients may refuse to take any form of treatment procedure or medication proposed by a health care practitioner. In such situations, there are ethical issues and conflicts that arise between the ethical principles that guide the health care profession. A patient’s refusal of treatment leads to a conflict between the principles of respects for patient’s autonomy in health care decisions and the principle of beneficence (NCEHC, 2009).
Patient autonomy in making health care decisions is a worthy ethical principle that all health care practitioners should respect, because it is in the best interests of the patients
(Garrett & Ballie, 2001). However, Health care practitioner beneficence is an equally important ethical principle because Health care practitioners must provide the best treatment to patients to eliminate any harm from them (NCEHC, 2009).
When the issue of a patient refusal of medication is viewed from a medical perspective, any refusal of a treatment procedure or medication is regarded as difficult to accept or irrational by health care practitioners. This is because the health care practitioners are guided by the ethical value of beneficence in their practice (Arnold, 2009).
Health care practitioners normally use goal-oriented rationality in approaching treatment while patients normally use value-oriented rationality in making a decision about treatment. Health care practitioners are only interested in eliminating harm from patient through offering beneficial treatment to the patients. Health care practitioners must also appreciate the value-based approaches of used by patients in making health care decisions (Arnold, 2009).
The Health care practitioner must therefore, evaluate the rationality of the decision making process of the patient to understand the reasons for patient refusal of treatment. The work of the Health care practitioner is providing a patient with knowledge and treatment options to ensure that the patient makes an informed decision in deciding whether to accept or refuse treatment (NCEHC, 2005).
Health care practitioners normally use medical perspectives in determining whether the decision of the patient is rational. These medical perspectives consist of scientifically agreed perspectives about a treatment procedure like the benefits and side effects of a treatment process. It is always hard for Health care practitioners to accept the decision of a patient whose decision they consider irrational (NCEHC, 2005).
Patients mainly consider both medical and other personal considerations in deciding whether to accept or refuse treatment. Medical issues that may make a patient refuse treatment include the cost of treatment, the length of treatment, and the side effects of medicine. Personal considerations include religion and personal values like emotional reasons (NCEHC, 2009).
Everyday patients are faced with the decision of deciding whether to accept treatment that may be painful, frightening or potentially deadly to them or deciding between the quality and the quality of life that a treatment option may bring. Some treatment choices may not yield the choices that a patient might prefer and therefore, make them to refuse treatment (Arnold, 2009).
However, tempting it may be for a Health care practitioner to override the decision of the patient due to the competing principle of beneficence and duty to protect life of patients, a Health care practitioner must accept the decision of the patient (Garrett & Ballie, 2001).Other issues that may make a patient refuse treatment include non-life threatening treatment decisions .An example is where treatment is being advocated for non-life threatening conditions like weight problems (Arnold, 2009).
Other cases that can make a patient refuse treatment include the end of life care .Patients may refuse treatment for terminal illnesses to end their suffering. Financial reasons are other forms of treatment that may make patients refuse treatment. When the treatment procedure is very expensive, it might make a patient choose between financial health and physical health. Religion is also another major factor that any make a patient to refuse life saving treatment (Arnold, 2009).
The autonomy of the patient matters for the patient and the health care practitioner. The decision of the patient to refuse treatment is a personal decision chosen according to the best interests of a patient. This action should not be breached even if the treatment is the best option for a patient. This right is very essential in health care ethics. Health care practitioners should never assume that patients do not have the capacity to make independent decisions on treatment choices (Garrett & Ballie, 2001).
A decision-making capacity assessment is important if the health practitioner believes that the patient lacks one or more tenets of rational decision-making. If the patient has good decision-making ability, the health practitioners must honor the decision of a patient to refuse treatment even if he/she believes the decision the patient takes is not the best (Say &Thompson, 2003).
However, a health practitioner must question and discuss the decision to refuse treatment with the patient. Health care practitioners should never persuade or coerce a patient to accept any form of treatment that makes a patient uncomfortable. A doctor must explore all the reasons that a patient raises for refusal of treatment or medication. This exploration is important because it may make a health care practitioner learn that all a patient needs is more information before accepting a treatment procedure. The professional ethical ideals of a shared decision making process between the patient and the health care practitioner must involve an active engagement with the patient and must be respected at all times (NCEHC, 2005).
As a prelude to the Health care practitioner exploration of the factors that make a patient to refuse treatment, the Health care practitioner should describe and clarify to the patients an understanding of the clinical situation and outlines the expectations of the client on the treatment procedure. Health practitioners should also address the goals of treatment with the client and ask for any questions from the client in a very non-judgmental way (NCEHC, 2005).
Resistance of treatment by a patient should always prompt health practitioners to reflect whether the treatments are very essential for a client in the light of the established goals between the client and the Health care practitioner. Patients who refuse treatment are a unique challenge to the health profession. The cause of all resistance to treatment should be evaluated and other clinical acceptable outcomes of the proposed treatments evaluated as well (NCEHC, 2009).
Health care practitioners also face different concerns when dealing with patients who lack a decision-making ability. A surrogate can consent treatment on behalf of the patient with no decision-making ability and Health care practitioner can progress treatment even when a patient refuses treatment. The Health care practitioner must also be sensitive to the wishes of the client and try to understand the actions of the patient even when a third party gives consent (NCEHC, 2005).
There are also instances where laws may make a health care practitioner override the decision of the patient to refuse treatment. A judge or state agents make these decisions regarding violations of a patient’s right to autonomy in making health care decisions. An example is working compensation where an injury in the course of working can specify the compensation to cover the cost of treatment that a patient cannot refuse. Social security disability and private disability claims are other factors that may make patients right to refuse treatment be overridden (Arnold, 2009).
It is ethical wrong and inhuman for health care practitioners to treat patients against their wishes. It is very wrong for health care professionals to override the decision of the client to refuse treatment procedures. Cases of patients refusing treatment Cleary illustrate the ethical, social and medical dilemmas that arise when a patient refuses to accept medication (NCEHC, 2005).
Unless otherwise stipulated by state laws, the right of a patient to refuse treatment cannot be overridden by a doctor even though it may not be the best decision for a patient (Say &Thompson, 2003). The grueling questions and perspectives that health professionals evaluate during the process of accepting the right of a patient to refuse medication are very essential for the medical community to understand. This is very essential because Cases of patients refusing medical treatment are very common in hospitals.
References
Arnold R. (2009). What to do when a patient refuses treatment. Washington. End of life
Health care practitioner Resource center (EPERC).
Garrett T. & Ballie W. (2001). Health care ethics: principles and problems.
New Jersey:
Prentice Hall.
NCEHC (2009) Ethics consultations, responding to the ethics questions in health care
Washington: Author
(2005). When patients refuse treatment. Retrieved from
Www.ethics.va.gov/docs/infocus/infocus_20051201_when_patients_refuse_treatment.pdf
Say R. & Thompson R. (2003). “The importance of patient preference in treatment decisions
Challenges for doctors”. BMJ .327 (542-545).
