Informed refusal
Informed refusal is a crucial aspect of the medical decision-making process, emphasizing a patient's right to decline proposed treatments after being fully informed of the consequences. It complements the concept of informed consent, where healthcare providers must communicate the benefits, risks, and alternatives of recommended procedures. This practice has historical roots, dating back to ancient civilizations, and has evolved within ethical medical frameworks, particularly in response to past abuses in medical research, such as those exemplified by the Nuremberg Code.
When a patient refuses treatment, healthcare professionals are ethically obligated to ensure that the patient understands the implications of their decision, including potential health consequences and alternative options. The reasons for refusal can vary widely, from financial constraints to personal beliefs about end-of-life care. Despite their autonomy, patients may face challenges, such as being discharged from care if their refusal leads to legal concerns for the physician. Overall, informed refusal acknowledges the patient's right to make choices regarding their health while ensuring they are aware of the implications of those choices.
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Informed refusal
Informed refusal refers to the rights and responsibilities related to a medical patient who declines or refuses some form of medical treatment. It is part of the informed consent process, which addresses the responsibilities of a medical professional to tell a patient about the benefits, risks, and alternatives to any medical procedure being recommended. A patient usually signs an informed consent form when agreeing to a procedure or treatment and may also be asked to sign an informed refusal form when declining treatment.
Overview
Written records indicate that even in the time of the ancient Greeks and Romans, physicians were expected to make sure patients fully understood the benefits and risks of any treatments the physician proposed. Throughout time, the idea of making sure a patient agreed with planned treatments was incorporated into the code of ethical behavior expected of physicians. However, there have been physicians and researchers who ignored this principle for their own purposes. Medical crimes committed by Nazi researchers and physicians in World War II (1939–1945) led to the Nuremburg Code, which prohibits experimenting on people against their will. As the twentieth century progressed, there was increasing emphasis on building trust in the doctor-patient relationship by requiring the physician to make sure a patient understood the benefits, risks, and possible alternatives to any treatment that was recommended and get the patient to definitively agree to the treatment.
Informed refusal is the other side of the informed consent process. The right to decide to have or not have a treatment or procedure always rests with the patient, or, in the case of a minor child or someone who is incapacitated, a parent or guardian. Sometimes patients or those responsible for them do not want a specific treatment. When this happens, the physician is obligated to explain to the patient the potential consequences of refusing the treatment as well as any potential benefits and alternatives. This is called informed refusal.
There are many reasons a patient may refuse treatment. In some cases, refusal can be caused by fear or by being in denial about the condition. The patient may be intoxicated or otherwise temporarily impaired and not understand the need for treatment. In some cases, a patient may not have insurance coverage for the treatment and/or may not be able to afford the cost. Some patients, particularly those who have been diagnosed with conditions that will ultimately be fatal even with treatment, may opt not to spend the last days of their lives in a medical facility enduring difficult and often unpleasant treatments.
Regardless of the reason, the physician is required to make every effort to be sure the patient understands the need for the treatment, the potential alternatives that could be considered, and the risks of refusing treatment. Following this disclosure, the physician may require the patient to sign a form indicating that he or she has been informed of this and still refuses the treatment.
Patients have a right to make an informed refusal. However, in some cases, this may result in the physician discharging the patient from his or her care. This is because the physician may fear a lawsuit or other legal action resulting from the patient not receiving the recommended treatment.
Bibliography
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Mallardi, V. “The Origin of Informed Consent.” Acta Otolaryngologica, vol. 25, no. 5, Oct. 2005, pp. 312–327.
Marco, Catherine A., et al. “Refusal of Emergency Medical Treatment: Case Studies and Ethical Foundations.” American College of Emergency Physicians, 2017, www.annemergmed.com/article/S0196-0644(17)30453-5/pdf. Accessed 2 Oct. 2018.