Background A core aspect of American bioethics is that a competent adult patient has a right to refuse treatment, even when the physician believes that the treatment would be beneficial. At such a time it is easy to either question the patient’s capacity to make the decision or try even harder to convince them to change their mind.
Full Answer
When is it necessary to treat a patient who refuses treatment?
· Patients may refuse treatments for many reasons, including financial concerns, fear, misinformation, and personal values and beliefs. Exploring these reasons with the patient may reveal a solution or a different approach. Involve Family Members and Caregivers
Why is it so difficult to make medical decisions about treatment?
Background A core aspect of American bioethics is that a competent adult patient has a right to refuse treatment, even when the physician believes that the treatment would be beneficial. At such a time it is easy to either question the patient’s capacity to make the decision or try even harder to convince them to change their mind.
Should physicians deliver treatment against the patient’s wishes?
The overriding ethical principle in this case is respect for patient autonomy. Ethically and legally patients have the right to refuse life-sustaining treatment, including artificial nutrition and hydration. The Patient Self-Determination Act (1991) is a federal statute that reinforces patients' rights to refuse artificial hydration and nutrition.
When is treatment over a patient’s objection appropriate?
· A person may refuse to accept mental health treatment for many reasons, including: He may believe it indicates he is a failure. It may make him feel more vulnerable. He may be concerned about...
What is it called when a patient does not follow treatment?
“Intentional non-adherence is a process in which the patient actively decides not to use treatment or follow treatment recommendations, whereas unintentional non-adherence may be the result of forgetfulness, not knowing exactly how to use medications, or other unplanned behaviour.”1 It may also include missing ...
Is a patient allowed to refuse treatment?
Under federal law, the Patient Self-Determination Act (PSDA) guarantees the right to refuse life sustaining treatment at the end of life.
Do patients have the ethical right to refuse 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.
Why do patients not comply with treatment?
One of the major reasons that patients become non adherent is because they forget to take their medications. Results of a study conducted showed that 49.6% of patients mentioned forgetfulness as one of the major non-intentional reasons for non adherence.
Can you be forced to have medical treatment?
When a healthcare provider sufficiently informs you about the treatment options, you have the right to accept or refuse treatment. It is unethical to physically force or coerce someone into treatment against their will if they are of sound mind and are mentally capable of making an informed decision.
What does the Constitution say about refusing medical treatment?
The Fourteenth Amendment provides that no State shall "deprive any person of life, liberty, or property, without due process of law." The principle that a competent person has a constitutionally protected liberty interest in refusing unwanted medical treatment may be inferred from our prior decisions.
What should a nurse do when a patient refuses treatment?
If your patient refuses treatment or medication, your first responsibility is to make sure that he's been informed about the possible consequences of his decision in terms he can understand. If he doesn't speak or understand English well, arrange for a translator.
What would you do 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 the 7 rights of a patient?
Your Legal Rights as a Patient in the American Healthcare SystemThe Right to Be Treated with Respect.The Right to Obtain Your Medical Records.The Right to Privacy of Your Medical Records.The Right to Make a Treatment Choice.The Right to Informed Consent.The Right to Refuse Treatment.More items...•
What happens when a patient is non compliant?
The term “non-compliant patient” generally refers to a patient who intentionally refuses to take a prescribed medication or does not follow the doctor's treatment recommendations. A non-adherent patient, on the other hand, refers to someone who unintentionally refuses treatment.
What is the consequence of non-compliance?
Non-compliance leaves you at risk for financial losses, security breaches, license revocations, business disruptions, poor patient care, erosion of trust, and a damaged reputation. Here is a quick overview of the impact of non-compliance.
What are the consequences of non adherence?
Consequences of nonadherence include worsening condition, increased comorbid diseases, increased health care costs, and death. Nonadherence results from many causes; therefore, no easy solutions exist.
Is fast facts medical advice?
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.
Do you need to consult the prescribing information before using a product?
Some Fast Facts cite the use of a product in a dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.
What is the importance of discussing a patient's case together?
Minimize confusion. A patient’s care is often divided among multiple clinicians, so it is essential for them to discuss the case together. This doesn't mean making decisions for the patient. Rather, this means achieving professional consensus about the options and their corresponding risks and benefits so that family members receive consistent information from caregivers about potential next steps.
How can physicians engage patients in decision making?
Physicians can engage patients about decision-making in ways that are inclusive of family input, and help consider possible roles of surrogate decision-makers for patients who do not have decision-making capacity.
What is patient autonomy?
Patient autonomy has traditionally been one of the most prominent principles of American medical ethics, but often patients don’t make decisions about their care alone. Some choose to involve family members, even sometimes allowing the family’s desires to supersede their own. Respecting autonomy necessarily means respecting patients’ decisions.
How to encourage patients to share their hopes?
Encourage the patient to be open. Remind patients that their family members might be more open to their desired care options than they think, and encourage patients to share their hopes.
How to help family members at end of life?
Help everyone identify their values. Studies show patients’ values and those of their family members are often closely aligned, so facilitating a discussion about goals and values— especially independence—can generate consensus. In the case of end-of-life situations , this can help family members understand and respect each other’s perspectives.
What happens if speech language pathologists do not eliminate aspiration?
If treatment procedures do not eliminate aspiration, then the speech-language pathologist must decide whether or not to assist the patient in oral feeding. The concern of course is to reduce the speech-language pathologist's liability should the patient get pneumonia and/or die because of eating orally.
What is the ethical principle of respect for patient autonomy?
Respect for patient autonomy is the primary ethical principle to employ when a patient is able to make deci-sions for him/herself. It may appear to clinicians that the burdens of foregoing tube feeding outweigh the benefits.
Why do speech pathologists want to prevent aspiration?
The speech-language pathologist's wish to prevent aspiration and prolong life conflicts with the patient's wishes for comfort and avoiding life prolongation using tube feeding. Many speech-language pathologists are uncomfortable feeding a patient who aspirates, and may worry about legal liability.
What is the Patient Self-Determination Act?
The Patient Self-Determination Act (1991) is a federal statute that reinforces patients' rights to refuse artificial hydration and nutrition. This right was determined in constitutional law in the case of Nancy Cruzan. Thus, the recommendations of the ethics consultants were solidly based on both ethics and law.
What is the bottom line of a patient?
The "bottom line" is whether the patient has decision-making capacity (DMC). Does Mr. Brown understand the infor-mation regarding his condition? Does he comprehend the consequences of treatment versus non-treatment? Finally, can he weigh all the options and communicate a decision? If Mr. Brown possesses these abilities, he has the right to refuse treatment. Respect for patient autonomy is the primary ethical principle to employ when a patient is able to make deci-sions for him/herself.
Is oral feeding a viable option?
A time-limited trial of oral feeding or tube feeding may be a viable option. This involves a treatment plan that includes specific criteria for revisiting the decision. For example, Mr. Brown could eat orally and agree to reconsider a tube if he develops complications.
Can a speech pathologist help with aspiration?
If dysphagia treatment had any impact in eliminating aspiration, Mr. Brown might be able to supplement the tube feeding with some food or liquid by mouth. This combination approach may be more acceptable to him. If treatment procedures do not eliminate aspiration, then the speech-language pathologist must decide whether or not to assist the patient in oral feeding. The concern of course is to reduce the speech-language pathologist's liability should the patient get pneumonia and/or die because of eating orally. Despite the family's agreement with the patient's wishes, they may still sue the clinician for recommending feeding if it leads to the patient's demise. The radiographic study may show that the patient aspirates only 20% using a specific treatment procedure, versus 80% without the procedure. Thus, the speech-language pathologist could assist the patient's caregivers indirectly by providing optimal feeding strategies, while still maintaining the initial recommendation regarding non-oral feeding.
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.
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!
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.
What to do if it is unclear whether the patient has capacity to refuse treatment?
Seek specialist advice (for example, from a psychiatry team) if it is unclear whether the patient has capacity to refuse treatment and which legal framework should be used
Why is informal treatment no longer appropriate?
The full reasons why informal treatment is no longer appropriate are documented; include mental state abnormalities and potential risks to the patient or others (or both)
What are the three legal frameworks for treating someone who refuses treatment?
In essence, there are three legal frameworks for treating someone who refuses treatment: (the) common law, the 2005 MCA, 4 and the 1983 MHA. 5 All clinicians need to be familiar with these frameworks (table 1 ⇓ ).
Why is it important to not assume lack of capacity?
In less clear cut cases of delirium it is important not to assume lack of capacity because the patient has a history of mental illness. It is also important not to assume that all behavioural change in a patient with severe mental illness is due to the mental illness because this risks other treatable causes, such as delirium, being missed. Sometimes it can be difficult to distinguish between mental disturbance caused by an organic illness (such as delirium) or a primary mental illness (such as relapse of schizophrenia). In such cases it is advisable to seek specialist support from a liaison psychiatry service or on-call psychiatrist.
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.
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.
Who should assess a patient's capacity to make a decision?
The code of practice stipulates that a patient’s capacity to make a decision should be assessed by the person directly concerned with the patient at the time the decision needs to be made. 10 In most instances of hospital inpatient care, the professional within the multidisciplinary treating team responsible for the patient’s treatment will be responsible for ensuring that a capacity assessment has taken place. However, when the existence of a disorder of the mind or brain, or the presence of capacity, is unclear, specialist support should be sought from a psychiatry colleague.
