Patients have a well-defined right to refuse care based on the principle of autonomy and legally grounded in the due process clause of the 14th Amendment, as established in the 1990 Cruzan case. 2 The 2011 American Medical Association Code of Ethics states that physicians have an obligation to discuss benefits, risks, and costs of appropriate interventions, and patients then have the right to accept or refuse any recommended medical treatment. 3 If an informed patient refuses care and declines further follow-up, the oncologist's role is limited.
Full Answer
Can family members disagree with cancer patients about treatment?
A person with cancer may have more than 1 option for treating the disease. In making this choice, patients often ask for the opinions of family members. In some cases, family members may disagree with each other and with the patient. This can create conflict when family members need each other's support the most.
Can a person with cancer have more than one option for treatment?
A person with cancer may have more than 1 option for treating the disease. In making this choice, patients often ask for the opinions of family members. In some cases, family members may disagree with each other and with the patient.
What happens when doctors and patients disagree?
When Doctors and Patients Disagree: Legal and Ethical Considerations. When the ethics committee's decision supports the physician, the physician must continue treatment for 10 days while the patient attempts to transfer. Patients (or their families) may take the physician and institution to court to extend the deadline for withdrawal of treatment.
How do patients make the decision to undergo conventional cancer treatment?
Treatment decision making is an ongoing process; thus, patients who initially refuse treatment may later choose to undergo conventional cancer treatment if given the adequate support, information, and time necessary to make the decision.
What do you do if someone refuses treatment for cancer?
If you feel your loved one is refusing treatment because of denial, or because of fear of undergoing treatment, talk to the oncologist. You may want to visit a counselor or support group together.
Why do some cancer patients refuse chemotherapy?
Concerns About Chemo and Your Natural Defenses A growing population of adults are choosing to refuse chemo is based on the way in which it works. Chemotherapy does not kill your immune system as claimed, but it can harm it temporarily.
Why do some patients refuse treatment?
Explore Reasons Behind Refusal 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.
What percentage of cancer patients get a second opinion?
A review of 20 quantitative studies of patients with cancer seeking second opinions found that the rates of seeking second opinions ranged between 1 and 88% [1]. Patients with higher levels of education were more likely to seek second opinions than other patients [1].
Do oncologists lie about prognosis?
Oncologists often do not give honest prognostic and treatment-effect information to patients with advanced disease, trying not to “take away hope.” The authors, however, find that hope is maintained when patients with advanced cancer are given truthful prognostic and treatment information, even when the news is bad.
When do doctors decide not to treat cancer?
If the cancer cannot be cured If a cure is not possible and treatment aims to control the cancer, it may be difficult to decide whether to go ahead. If the cancer is advanced and has spread to other parts of the body, treatment may be able to control it, improving symptoms and quality of life.
What do you do if a patient refuses medical treatment?
Understand their story Try to understand the patient/family's story before you try to change their mind. This means suspending your attitude toward their decision and as openly and non-judgmentally as possible, understanding the reasons for their decision.
How do you please a patient that doesn't like to be treated by you?
5 Tips for Handling Difficult PatientsListen to the complaint and identify the problem. ... Don't lose control. ... Remind the patient you expect to be treated with respect. ... Empathize with the patient. ... Find a solution.
What is the term 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.
Do doctors get mad when you get a second opinion?
In serious cases, it can even save your life. But, pursuing a second opinion can add more stress to the situation if you are afraid your current doctor could get offended, resulting in a conflict. While it is not impossible for a doctor to get offended, thankfully it happens less than you may fear.
When should you get a second opinion cancer?
Doctors are usually happy to help patients arrange a second opinion. Your doctor may even recommend it when the best treatment approach for your cancer is not clear. You should seriously think about getting a second opinion if: You have been diagnosed with a rare type of cancer.
Does Medicare cover a second opinion?
Medicare covers second opinions if a doctor recommends that you have surgery or a major diagnostic or therapeutic procedure. Note: Medicare does not cover second opinions for excluded services, such as cosmetic surgery.
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.
Case
Mr. A is making his first visit to Dr. M, an oncologist, because of debilitating bone pain and severe constipation. For the past year, he has been treated for cancer of unknown origin by a state-licensed naturopathic physician whom he has seen extensively over the years for what Mr. A explains were a variety of autoimmune diseases and infections.
Commentary
This case is one that students will begin to see more and more often as naturopathic medicine increases in popularity across the country.
Author Information
Ryan Blum is a second-year medical student at Yale School of Medicine.
What is shared decision making in cancer care?
In cancer care, we believe in a model of shared decision making. 1 This is particularly true in the management of early-stage breast cancer, which can involve difficult decisions regarding surgical approach and adjuvant therapy. Patient preferences weigh heavily in determining the ultimate course of care. Oncologists understand that a patient may decline therapy or a component of therapy regardless of the physician's recommendation. However, although there has been considerable attention in the literature to shared decision making, there has been relatively little attention to what happens when patients and physicians disagree. What are the oncologist's obligations in the ongoing care of that patient?
How many people with breast cancer use complementary therapy?
Forty percent to 66% of patients with breast cancer report that they use at least some form of complementary therapy in addition to conventional therapy. 4 In most settings, the potential risks and benefits of adding such therapy to conventional treatment are unknown.
What does it mean when a patient chooses alternative therapy?
In choosing to undergo alternative therapy, the patient is indicating that she remains concerned by the risk of recurrence and wishes to take action. She believes the herbal therapy is an acceptable alternative to surgery. The oncologist disagrees and feels that she is acting on misinformation.
What is the obligation of an oncologist?
The oncologist has the obligation at the time of initial consultation to educate the patient regarding the prognosis, options, and potential consequences of declining therapy. Patients should be informed whether the decision to forgo a therapy will limit their future options.
What is the role of an oncologist in alternative care?
The oncologist is asked to use his or her medical authority to order laboratory and imaging tests that would otherwise be unattainable or prohibitively expensive for the patient.
What is a physician's license?
As is the case with pain medication, a physician's medical license provides authority to order tests and procedures that cannot be ordered by some alternative practitioners. The physician's order implies medical necessity and is often required for insurance coverage. In some cases, an alternative practitioner may even request a procedure such as central intravenous catheter placement that might facilitate alternative therapy administration.
What is the primary obligation of a physician?
A physician's primary obligation is to the interests and well being of his or her patients. This includes not only the impetus to promote a patient's health, termed beneficence, but also an obligation to respect the patient's individual goals and preferences for his or her care, termed respect for autonomy.
Is there enough time to wait for a second opinion?
Treatment decisions should be made after you have learned all you can about your diagnosis, prognosis, and available treatment options. This can take time, depending on the type of cancer you have. In a few cancers, there are some treatment decisions that have to be made right away.
Remembering what your doctor says
It’s hard to understand complex information when you are anxious or afraid. And sometimes, without knowing it, doctors use words that you don’t understand. If you don’t understand something, ask your doctor to explain it to you.
How to talk to your doctor about getting a second opinion
Some people find it hard to tell their doctors that they’d like a second opinion. Remember it is common for patients to get a second opinion, and doctors are comfortable with the request. If you are unsure of how to begin, here are a few ways to start the conversation:
The second opinion process: what to expect
Before you start looking for a second opinion, contact your insurance company to find out what your policy covers. In some cases, you may have to get a second opinion from another doctor who is part of your health plan before the plan will pay for your treatment
Deciding where to go for a second opinion
Let your doctor know if you want to get a second opinion. Most doctors understand the value of a second opinion, and they are not offended when a patient wants one. They may even be able to recommend another doctor.
Making sense of the second opinion
Although cancer patients seem to be asking for a second opinion more frequently, studies show the benefits of getting one are unclear . If the second opinion differs from the first, you may find the following tips helpful:
What is hospice discussion?
Viewed in these terms, a hospice discussion offers an opportunity to recalibrate the patient’s expectations and to set goals that are achievable.
Why did the doctors discharge the sailor?
This time, the care team planned to discharge him as soon as possible because of his poor prognosis and the possibility of his acquiring another infection.
Can a physician abandon a patient?
It is essential, though, that they discuss their differences openly. A physician’s primary obligation is to the patient, and it is never appropriate for a physician to abandon a patient, as this oncologist appears about to do, over a clinical disagreement with other members of the health care team.
Can a physician discuss hospice?
Physicians’ own fears and uncertainties should not prevent them from discussing hospice when it appears to be an appropriate option. Of course, as with many end-of-life discussions, discussion of hospice can be emotional, particularly when patients and families have strong preconceived ideas about hospice care. However, the communication techniques summarized here can make hospice discussions easier for physicians, as well as for patients and families.
Evaluating Treatment Options
Continuing to Communicate
- Making treatment decisions may require many conversations with the health care team and loved ones. One of the first questions to ask the doctor is, “When do decisions need to be made?” Often, a decision is not needed right away. This can lower the level of anxiety for everyone involved in reviewing the options.
Legal Considerations
- An advance directive is a legal document that tells the health care team what to do if the patient is unable to make decisions. The patient is the only person who can change or cancel these documents. Regardless of their health, all people should have advance directives, including the following: 1. Living Will. This document gives instructions about the health care that the patient …
Special Circumstances
- State laws vary about the age at which a child can make his or her own medical decisions. Most laws consider a child's best interests and ability to make his or her own decisions and understand the potential consequences of those decisions. Typically, the parents make decisions for a child who is younger than the state's age limit. If an adult patient is unable to make medical decisions…