Are seriously medically ill patients who refuse life-saving treatment mentally competent?
Results: Over the past 20 years, the burden of proof concerning the mental competence of seriously medically ill patients who refuse lifesaving treatment has shifted to the persons who seek to override these refusals.
Is the patient competent to make medical decisions?
Valid informed consent requires that the patient be competent to make medical decisions. Physicians often make assessments of patient competence without using specific criteria and without being certain of the legal requirements. This article will provide a framework for the evaluation of patient competence.
Who makes decisions about treatment for patients with lack of capacity?
Still other jurisdictions may require that a committee of physicians, hospital administrators, and spouse or other family member make treatment decisions regarding treatment for the patient who lacks capacity. Consultation with knowledgeable legal council in one's jurisdiction may be particularly helpful in clarifying which of these rules apply.
Can an individual refuse to accept a treatment or diagnostic intervention?
It stands to reason that an individual who cannot understand what he or she has been told about a proposed treatment or diagnostic intervention is not capable to decide to assent or refuse.
What competency is related to the right to refuse treatment?
Common law dictates that individuals possess autonomy and self-determination, which encompass the right to accept or refuse medical treatment.
Who determines competency in a patient?
judgeCompetency is a global assessment and legal determination made by a judge in court. Capacity is a functional assessment and a clinical determination about a specific decision that can be made by any clinician familiar with a patient's case.
What 3 elements must a patient demonstrate in order for a refusal to be lawful?
3) In order for a patient to refuse treatment and/or transportation two events must occur to protect both the patient and yourself: 1) You must give the patient enough information about the decision Page 2 2 they are making so that there is an informed consent, and; 2) You must be satisfied that the patient has ...
Can competent patients refuse medical 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.
What is the criteria for determining competency?
In determining whether the defendant is competent to stand trial, the court must determine "whether [the defendant] has sufficient present ability to consult with his lawyer with a reasonable degree of rational understanding -- and whether he has a rational as well as factual understanding of the proceedings against ...
How is competency evaluated?
A competency evaluation is a court-ordered mental health assessment to determine how much a defendant remembers and understands about his or her charges and alleged offense, as well as his or her capacity to understand court proceedings and assist a lawyer in their defense.
What are the 3 factors that are required for consent to be valid?
Defining consent For consent to be valid, it must be voluntary and informed, and the person consenting must have the capacity to make the decision.
How do you deal with a patient refusing treatment?
When Patients Refuse TreatmentPatient Education, Understanding, and Informed Consent. ... Explore Reasons Behind Refusal. ... Involve Family Members and Caregivers. ... Document Your Actions. ... Keep the Door Open.
What are the 3 main requirements of valid consent?
That is, the patient must have capacity to consent, the consent must be freely given and be sufficiently specific to the treatment, and the patient must be informed about the procedure and any material risks.
How do you document patient refusal?
DOCUMENTING INFORMED REFUSALdescribe the intervention offered;identify the reasons the intervention was offered;identify the potential benefits and risks of the intervention;note that the patient has been told of the risks — including possible jeopardy to life or health — in not accepting the intervention;More items...
What are the ethical and legal considerations involved in refusing patient service?
Both the ethical opinions and legal precedents agree that a physician may not intentionally and unilaterally sever an existing relationship with any patient, unless the physician provides reasonable notice to the patient, in writing, and sufficient time to locate another physician.
Should a competent patient have the right to refuse a treatment?
Every competent adult has the right to refuse unwanted medical treatment. This is part of the right of every individual to choose what will be done to their own body, and it applies even when refusing treatment means that the person may die.
What are the two considerations that affect the degree to which the level of capacity required for competence varies in response to
Two other considerations seem further to affect the degree to which the level of capacity required for competence varies in response to what is at stake. Medical ethics. The principle of beneficence includes injunctions not to do harm, to prevent evil or harm, to remove evil or harm and to promote good.
What happens if there is a principle that operates to raise the threshold level of mental capacity required for legal competence?
If there is a principle that operates to raise the threshold level of mental capacity required for legal competence, therefore, the operation of that principle may be limited at extremes of capacity and gravity. The practical consequences have not been described systematically.
What is the assessment of mental capacity?
Deciding whether someone is legally competent to make decisions regarding their own treatment requires an assessment of their mental capacity. The assessed capacity required for legal competence increases with the seriousness of what is at stake.
What is the usual explanation for patient autonomy?
The usual explanation is that patient autonomy is being balanced against best interests. An alternative explanation, that we require greater room for error when the consequences are serious, implies a change to clinical practice and in the evidence doctors offer in court. INTRODUCTION. When a patient refuses medical treatment, the law in the UK, ...
Is a measurement of capacity subject to error?
Any measurement of capacity is subject to error, and any legal judgment that someone is competent to make a decision that is based on a measurement of capacity will be similarly susceptible. In practice, competence is only at issue when a patient decides contrary to what others regard as in their best interests.
Is legal competence present?
Legal competence, however, cannot be present to a greater or lesser extent. A person is either entitled or not entitled, at law, to have their wishes respected regarding treatment. Doctors, patients' relatives and, in contested cases, the courts have to decide, where someone's right to accept or refuse treatment is in doubt, ...
Is mental capacity a determinant of what will happen when a patient chooses a course of treatment
Mental capacity is not the sole determinant of what will happen when a patient chooses a course of treatment that doctors consider against that patient's best interests. The views of relatives, the previously expressed views of the patient, the opinions of hospital staff and society's values all have a currency.
Who should be responsible for the evaluation of a patient's competence?
The attending physician should be responsible for the evaluation of a patient's competence. It is the attending physician who should have the best knowledge of the patient's situation, prognosis, course of disease, information received, previous decision-making capacity and previously stated health care preferences.
When is competence questioned?
Google Scholar. Competence is typically questioned only when a patient chooses a treatment course other than that advocated by the treating physician. Scrutiny is rare when a patient assents to a procedure or treatment plan, even if the patient is not fully competent. 5.
What is the problem with the incompetency exception to informed consent?
The problem raised by the incompetency exception to informed consent is that of specifying the circumstances in which the exception applies. In order to specify these circumstances, incompetency must be defined. Unfortunately, there is no single or well-accepted definition of incompetence.
What is the importance of physician evaluation of patient competence?
Valid informed consent requires that the patient be competent to make medical decisions.
What factors affect the determination of incapacity?
There are many clinical factors that are likely to affect the assessment of competency. These include but are not limited to: psychodynamic factors, information provided to the patient, stability of the patient's mental status and setting. The idiosyncratic meaning for the patient of any suggested procedure is a function of each patient's unique previous experiences. If the proposed treatment or procedure is sufficiently provocative of anxiety and fear, the recommendation for the procedure itself may force the patient into an apparently incompetent state. The psychodynamic basis of a patient's refusal to consent should thus be explored prior to determination of incompetence.
Why should patients be evaluated for decision making capacity?
Patients who appear competent as well as those who seem to be incompetent should be evaluated for decision making capacity in order to preserve the competent patient's right to autonomy and to protect the incompetent patient's well-being. Physicians frequently assess patient competence.
What is the purpose of the Reasonable outcome test?
The “reasonable” outcome test of competency requires that the patient reach a decision that is “reasonable,” “right” or “responsible.”. The emphasis is on the conclusion reached , rather than on the presence of a decision or the process involved in decision making.