helping patients who refuse treatment

When Patients Refuse Treatment

• Patient Education, Understanding, and Informed Consent. The physician’s first responsibility is to ensure that the...
• Explore Reasons Behind Refusal. Patients may refuse treatments for many reasons, including financial concerns, fear,...
• Involve Family Members and Caregivers. Involving family members and other loved ones in the conversation...

Full Answer

When May a physician refuse to treat a patient?

There are a few reasons why a doctor can refuse to treat a patient. The most obvious of these is if the doctor does not treat patients with the patient’s specific condition. For example, an individual suffering from a throat infection cannot realistically expect a gynecologist to diagnose and treat his or her condition.

What happens if a patient refuses to consent to treatment?

In some places, the patient would be allowed to stay home, and in others he would be legally compelled to go to the ED. In almost every instance, if the patient suffered cardiac arrest, or was otherwise unable to make decisions, the wishes of his power of attorney would need to be followed.

What to do when someone refuses treatment?

Signs can include:

• Disorganized thoughts
• Hallucinations
• Delusions
• Suicidal ideation
• Withdrawal and isolation
• Difficulty with communicating
• Bizarre actions

What does a nurse do when the patient refuses care?

The patient has the right to refuse any given intervention, or all of them, if they are mentally competent. It’s part of the nurse’s job to record how they explained it to the patient, why the patient did not want it done, and anything else that might be relevant.

How do you help someone who doesn't want help?

Keep a positive attitude; it may rub off on the patient. Describe your care in a positive way, whether it is referring to respite care as something one may enjoy or by calling yourself a friend. Enlist the help of the patient's family caregivers. Speak with them about the benefits of the care offered.

What is it called when a patient refuses treatment?

Informed refusal is where a person has refused a recommended medical treatment based upon an understanding of the facts and implications of not following the treatment. Informed refusal is linked to the informed consent process, as a patient has a right to consent, but also may choose to refuse.

How would you respond to a patient who is refusing consent to receive medical care due to a cultural belief?

Simply, if an adult under your care is mentally competent and refuses a treatment, including blood transfusions, surgery, or standard medical care, based on a held religious or cultural belief, the law generally grants this right of choice—even if the consequences of refusal are dire.

What is the role of the nurse when a client refuses treatment?

1. Because a client legally has the right to refuse medication, the nurse can only recommend, advise, suggest, or urge the patient to comply. Consequently, it is important to understand the nurse's response to patient refusal of medication.

What should be done if a patient refuses treatment for a life threatening condition?

Where a competent adult refuses treatment recommended by guidelines, the doctor is bound to respect that refusal. If he does not, the doctor may face disciplinary action by the General Medical Council, plus possible civil and criminal proceedings in battery.

What are a few examples of when a patient can refuse treatment?

1 Accordingly, the patient may refuse to be informed about their medical condition and make a decision. An example would be the statement, “I don't want to hear anything from you. I'm not going to the hospital.” They may be informed and then refuse to make a decision. “Wow, that sounds bad either way.

What should a doctor do if a patient refuses life saving treatment for religious reasons?

Three physician experts suggest that to discern when to accommodate a patient's refusal of treatment on religious grounds, doctors should embrace medicine's traditional orientation toward preserving and restoring health.

Do patients have the right to refuse treatment?

You cannot legally be treated without your consent as a voluntary patient – you have the right to refuse treatment. This includes refusing medication that might be prescribed to you. (An exception to this is if you lack capacity to consent to treatment.)

Why is refusal of treatment an ethical dilemma?

In general, ethical tension exists when a physician's obligation to promote a patient's best interests competes with the physician's obligation to respect the patient's autonomy. “When you don't take your medication, you're more likely to get sick.”

What is the nurse's legal and ethical responsibilities toward the patient who refuses medical care or treatment?

They must maintain patient confidentiality and observe the right to refuse treatment. Nurses should also be involved in informed consent, medical treatment in an emergency, and continuity of care.

Is it ever ethical to treat someone who refuses treatment?

Competent patients have a right to refuse treatment. This concept is supported not only by the ethical principle of autonomy but also by U.S. statutes, regulations and case law. Competent adults can refuse care even if the care would likely save or prolong the patient's life.

How do you persuade a patient?

Listen actively Connecting with a patient emotionally is the first step to persuasion. Even further, the patient needs to see the physician listening and engaged in the conversation. Active listening is one tool in the arsenal — a way you may be able to understand the emotions behind the words.

When acting against a patient's wishes, is the MCA used?

As a general rule, when acting against a patient’s wishes, the MCA is used to treat physical disorders that affect brain function and the MHA is used to treat primary mental (psychiatric) disorders. In part two of the case scenario the patient’s behaviour has changed.

What is the first step in a mental health case?

The first is to determine the urgency of treatment to see whether common law is applicable. The second is to determine what is being treated—a primary physical (organic) disorder or a primary mental (psychiatric) disorder. We will now explain how to work through these two steps as we look at the evolving case scenario.

What is common law in emergency settings?

In the first part of the case scenario, failure to act immediately and treat the tension pneumothorax would probably result in serious harm to the patient. In such situations there is clearly not sufficient time for a formal assessment of capacity and common law should be used. Common law is widely used in emergency settings, because there is rarely time for consent. Clinicians are often unaware that they are using it and that it is the legal defence of their actions. No specific documentation is needed when using common law. However, the MCA and MHA should be the default legal frameworks when the situation is not immediately life threatening. Box 2 lists the key principles of common law.

Can patients be treated against their wishes?

Patients can be treated against their wishes only if their decision making capacity is impaired and if the proposed treatment is for something serious enough to warrant over-riding their wishes.

Can a section 5 order be used in an outpatient setting?

The patient is already admitted: a section 5 (2) order can be used only in the inpatient setting (but not emergency or outpatients departments, although in some trusts or health boards the clinical decisions unit may count as an inpatient setting)

Can a delirium patient use the MCA before the MHA?

Where possible, the MCA should be used before the MHA. In this case, it would also be appropriate to use the MHA to keep the patient on the ward to treat his mental disorder. If he refused treatment, ongoing treatment of his physical health conditions (femoral and pelvic fracture) would need to take place within the framework of the MCA.

What happens when someone you love refuses to get treatment?

When someone you love refuses to get professional treatment for their mental health disorder—such as depression, bipolar disorder, or substance abuse —this can put you, as a family member, in a very uncomfortable and difficult position. You care for the person and can see that he or she needs help, but feel powerless and unable to just stand by.

Why does my loved one refuse to move forward?

If your loved one refuses to move forward, it’s useful to try to understand what is behind his reasons for refusing treatment and then address those issues. A person may refuse to accept mental health treatment for many reasons, including: He may believe it indicates he is a failure.

What does it mean to distancing yourself from a sick family member?

That, a lot of times, means distancing yourself from the sick family member who refused treatment. Everyone has limits, and when said mentally sick family member has a long history of repeated abusive behavior I say family members have a right to protect themselves from harm.

What are the areas of concern?

Common areas of concern are: alterations in overall appearance. decreased level of energy. fatigue. lack of interest in previously enjoyed people or activities. changes in sleep, appetite, or weight.

Is it hard to keep up with meds?

It's really hard to keep up your motivation and keep on trying when so many things don' t go your way, when meds don't work or you have side effects to them. I know, I've been there too. It feels like you have nothing left to do, but actually there's always something else to try. This I know for sure.

Can elderly people not participate in treatment?

Other's won't participate, and, if they aren' t a danger to themselves or others, have a right to not participate in treatment. The author mentioned elderly people. Elderly people (probably over the age of 75 or so) didn't grow up with treatment options, and thus, many won' t participate in them.

Can an elderly parent be left alone?

If your family member who has depression is an elderly parent, you may have to arrange for someone to be with her so that she’s not left alone during the day when others in the family are away at work or school. Caring for someone is a full time job that is not easy. Good luck!

What are ethical issues in assisted reproduction?

There are many related ethical issues like determining who are the parents, whether someone should be able to carry a child for another couple, whether that person should be paid for those services. That’s a burgeoning area.

What is the role of an ethicist in a physician?

When the physician isn’t able to do that in a supportive way for the patient and the family, the ethicist’s role should be to advise the physician and the family about what the best ethical choice would be in the situation. Of course, no one has to follow the ethicist’s advice.

Can a patient refuse a blood transfusion?

Back in the day it would not be uncommon to override a patient’s wishes, such as if the patient refused a blood transfusion because of their religious beliefs. That was then, this is now. A number of benchmark court cases have recognized the patient’s right to refuse life-sustaining treatments such as transfusion, ventilation, nutrition, and hydration. That was a major shift.

What is the best way for a patient to indicate the right to refuse treatment?

Advance Directives. 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.

What are the rights of a patient who refuses treatment?

In addition, there are some patients who do not have the legal ability to say no to treatment. Most of these patients cannot refuse medical treatment, even if it is a non-life-threatening illness or injury: 1 Altered mental status: Patients may not have the right to refuse treatment if they have an altered mental status due to alcohol and drugs, brain injury, or psychiatric illness. 6  2 Children: A parent or guardian cannot refuse life-sustaining treatment or deny medical care from a child. This includes those with religious beliefs that discourage certain medical treatments. Parents cannot invoke their right to religious freedom to refuse treatment for a child. 7  3 A threat to the community: A patient's refusal of medical treatment cannot pose a threat to the community. Communicable diseases, for instance, would require treatment or isolation to prevent the spread to the general public. A mentally ill patient who poses a physical threat to himself or others is another example.

What is the end of life refusal?

End-of-Life-Care Refusal. Choosing to refuse treatment at the end of life addresses life-extending or life-saving treatment. The 1991 passage of the federal Patient Self-Determination Act (PSDA) guaranteed that Americans could choose to refuse life-sustaining treatment at the end of life. 9 .

How can a patient's wishes be honored?

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.

What must a physician do before a course of treatment?

Before a physician can begin any course of treatment, the physician must make the patient aware of what he plans to do . For any course of treatment that is above routine medical procedures, the physician must disclose as much information as possible so you may make an informed decision about your care.

What is a threat to the community?

A threat to the community: A patient's refusal of medical treatment cannot pose a threat to the community. Communicable diseases, for instance, would require treatment or isolation to prevent the spread to the general public. A mentally ill patient who poses a physical threat to himself or others is another example.

What are the four goals of medical treatment?

There are four goals of medical treatment —preventive, curative, management, and palliative. 2  When you are asked to decide whether to be treated or to choose from among several treatment options, you are choosing what you consider to be the best outcome from among those choices. Unfortunately, sometimes the choices you have won't yield ...

HOW DOES A PERSON FEEL WHEN THEY ARE ILL?

STAGE 1: When a person finds out that he has an incurable disease, he experiences 5 emotions before starting treatment. At first, the patient thinks that this is not true. He denies illness and is convinced that the doctor was wrong. Then he either ignores the diagnosis or checks the doctor.

WHY DOES THE PATIENT DELAY DIAGNOSTIC AND TREATMENT OF THE DISEASE AT AN EARLY STAGE?

A mild illness like the common cold is often underestimated and delayed in treatment. A person can go to work with a runny nose or cough for weeks. And there are other cases: when a symptom is a sign of the development of a dangerous disease. The patient ignores the disease until it develops into something more serious.

WHAT SHOULD YOU DO IF THE PATIENT REFUSES TO ACCEPT THAT THEY HAVE A DISEASE?

Denial is a natural defense of man. Awareness of a fatal diagnosis leads the patient into shock. All plans and goals now lose their meaning. The patient is not ready to give up the future and therefore behaves as if nothing happened. At this stage, he needs support and help. The patient should feel free to talk about their illness.

WHAT SHOULD BE DONE IF THE PATIENT TRUSTS IN NON-CONVENTIONAL MEDICINE?

Some patients do not trust doctors. Instead of going to the clinic for help, they turn to healers and traditional methods. These actions take important time and reduce your chances of recovery. The most famous example is the actions of Steve Jobs. Instead of immediately starting treatment, he meditated for 6 months.

WHAT SHOULD BE DONE IN THE EVENT THAT THE PATIENT HAS LOST ALL HOPE?

The most difficult case is when the patient ceases to believe in recovery. He understands that illness is his destiny. The patient gives up and floats with the flow of life, waiting for the disease to win. But they give up not because of the severity of the disease. The deeper reason is the loss of the meaning of life.

5 WAYS THROUGH WHICH YOU CAN HELP THE PATIENT

Health is a priority. If symptoms of the disease are noticeable, you need to postpone everything and go for a diagnosis. Loved ones can help by reminding them of the values of health or helping to cope with business. Early diagnosis of the disease can save a person’s life

Article 5-Freedom from Torture

While it may seem odd that I would choose an article that relates to torture, it is actually quite relevant to the medical field. While advancements have been great in our ability to control symptoms and cure disease, many treatments remain unpleasant at best.

About Tammy McKinney, RN

Tammy McKinney is a Registered Nurse from Pennsylvania. After earning her Business Administration degree, she went on to earn her degree in nursing from Pennsylvania College of Health Sciences. With a background in Infectious Disease Nursing, Agency Nursing, and Hospice Care she enjoys sharing her experiences through her writing.