¶ … Patient's Right to Refuse Medical Treatment
My topic is a patient's right to refuse treatment. Is it ok ethically to do so? Do they have the right to refuse treatment? DO healthcare worker have to abide by these wishes, or treat these patients anyway regardless of their wishes?
This paper focuses on a patient's inherent right to refuse medical treatment: just because a doctor or any other medical professional believes that a certain arena of medical care is in a patient's best interest, doesn't mean that the patient has to engage in this treatment. Rather, every step of the way, the patient absolutely has the specific right to engage in concerted and proactive choices about his treatment, even if the medical professionals around him disagree. This paper will discuss and examine the pillars and nuances of this concept, and how more healthcare professionals ought to be aware of and follow these pillars.
One of the major reasons that a patient has the right to refuse medical treatment, revolves around the pillar of autonomy. Autonomy refers to the independence and liberty of thought which all decision-making revolves around and the inherent right that any patient has in connection with self-determination. "Obtaining a patient's informed consent is generally a fundamental requirement before starting any form of treatment or healthcare intervention, including assistance with personal care needs" (Taylor, 2014). This is the fundamental pillar of providing care for a patient: making sure the patient is correctly satisfied with that care. This is so fundamental to the entire doctor-patient relationship, it must not be overlooked. However, too many doctors forget that they still have the obligation to respect a patient's wishes, regardless of what they believe. For example, some doctors have been so strongly programmed to save lives and to preserve lives that they have trouble comprehending or following a "do not resuscitate" policy that a patient has selected.
One of the aspects that goes hand in hand with autonomy, is the patient's inherent right to self-determination. While nearly all medical professionals will agree on the importance of this right, it can often get overlooked given the heat of the moment and is thus not always honored, but swept under the rug. "A refusal can be thwarted either because a patient is unable to competently communicate or because providers insist on continuing treatment. To help enhance the patient's right to refuse treatment, many states have enacted so-called 'living will' or 'natural death' statutes" (LAC, 1983). Thus, individuals like the Legal Advisors Committee believe foremost in the importance of a patient's self-determination and thus push for an act which more succinctly states a person's right to refuse treatment, in situations which are not just limited to the terminally ill or for heoroic measures: this act attempts to set cases during which people can establish their wishes ahead of time, allowing other individuals to fulfill them (LAC, 1983).
Respecting the fundamental right of self-determination is absolutely necessary when it comes to elderly patients. Thus, the right to refuse treatment is a right which geriatric patients need to have respected at all times. "Prior to treatment, nurses are often charged with obtaining the informed consent of the patient. To do so, the nurse must evaluate the patient's competency and mental capacity while explaining the proposed treatment, the benefits and risks involved, and other available treatment options, and then accept either the patient's voluntary assent or refusal" (Plawecki & Amrhein, 2009). This is a process that needs to have more nuances discussed and determined during the medical education of the clinician, as it is a process where the importance is fundamentally in the details. Obtaining informed consent is an extremely crucial necessity, and is something which is important for nurses to do with accuracy. It also exposes nurses to higher levels of liability and accountability than ever before, and that is something they need to be aware of (Plawecki & Amrhein, 2009). Though nurses need to understand that a certain aspect of the informed consent process revolves around having the patient potentially reject their suggestions, it is in this rejection that the patient is exercising their right to self-determination.
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One thus, needs to come to terms with the fact that patients have the right to make these choices regarding their health and that doctors and nurses might quite often disagree with them: however, this amount of disagreement doesn't make the patient's choice invalid. "It can be difficult for nurses and other Health professionals to accept that patients are sometimes adamant that they will not consent to treatment that could potentially save their life. The courts recognize this dilemma but are clear that nurses cannot act paternalistically to save a life when it is the clearly expressed wish of a capable adult that they do not want that" (Griffith, 2014). Thus, it needs to be more acutely part of the clinician training that they are to reach a deeper level of clarity and understanding with this aspect. The educational process that these individuals engage in needs to have one component where this issue is addressed and clinicians are made to understand that the fundamental decision for treatment belongs to the patient, even the right to make a bad decision. Clinicians and other such professionals have the duty to warn against such bad decisions, but that is all they can do at the end of the day: they cannot forcibly remove the patient's right to make decisions that they disagree with.
Another aspect of the training of health professionals revolves around the necessity of a brief education of world religious beliefs. This is largely because religious beliefs are fostered and supported by people all over the world, and many of these beliefs will impact their decision to have medical treatment or not. For instance Jehovah's Witnesses will refuse any kind of blood products; Christian Scientists will also refuse traditional medical treatment, preferring faith-healing and prayer (Wyatt, 2010). "The odds are, sometime in your career, you'll meet at least one patient who has chosen to decline chemotherapy or radiation because of his or her religious beliefs" (Wyatt, 2010). As health care professionals, one still needs to be able to respect the religious beliefs of one's patients, and these beliefs are often what helps them to get through the illness, and is what also helps them to understand reality. To so many people, their faith system is what helps them to process everything that is going on in their world. For a doctor to discount that, disregard it or to belittle it in any fashion is completely unacceptable. However, one must acknowledge that watching a patient refuse a life-saving treatment, based on such beliefs has got to be incredibly frustrating, even devastating. Thus, preparing for this process and understanding this process needs to be part of more medical training.
One of the issues that can occur that only works to make this issue seem more intricate is the fact that some argue that when a patient refuses treatment, the situation can start to resemble that of euthanasia. "In this reported case a mentally capable, but physically disabled man, wished to exercise the right to refuse treatment that kept him alive, save for the provision of pain relief as he approached death. His wishes were not abided by as Brightwater, the facility in which he was being cared for, were concerned that if staff complied with the man's wishes, they could be charged with a criminal offence related to the his death" (Mair, 2010). This was a case that was tried in Australia, and it's important to bear in mind that the ultimate findings do not actually legalize euthanasia. Rather they fight for a greater specificity of terms. "Any person, including a health professional, who intentionally does an act to cause the death of a patient or to hasten their death, no matter how terminally ill the patient is, commits a criminal offence. Nor does it create a precedent for the right to die" (Mair, 2010). Thus, one of the overwhelming benefits of this case is that it does demonstrate the distinction between the two. The case stresses to buttress the right of a person who is mentally competent but incapacitated to refuse unwanted treatment (Mair, 2010). Other such facts and cases need to be dealt with on a case by case basis (Mair, 2010).
However, it is worth discussing the times when patients are not capable of making their own treatment decisions. This revolves around times when the patient is not fully functioning with all cognitive abilities. "Practitioners may ask when decision-making capacity should be assessed. The general answer is that, unless it has been established that the patient has permanently lost the capacity to make decisions, for example if they are in the terminal…
From there, health care providers are becoming more assertive in denying services based on their religious beliefs (Friedman 2007). This debate has been going since a doctor refused medical treatment to a gay man. The dispute arose in 2000 after San Diego-area doctors Christine Brody and Douglas Fenton refused to artificially inseminate Benitez, a lesbian who lives with her partner, Joanne Clark, in Oceanside, north of San Diego (Parker
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