The first thing that comes to a physiotherapy student’s mind when you talk about human rights is patient’s rights because we deal with patients on a day to day basis. I asked casually before I wrote this piece a few of my classmates what right comes to mind when thinking about patient’s rights and most of them said the right to refuse treatment. I decided to go view what literature says about the right for a patient to refuse medical care. Is it an absolute right? Is it in the SA constitution? I think most us just use our thinking of who am I to stand on a patient’s way if they’re refusing treatment it’s their life and it’s their right to make their own decisions about their own bodies.
The human right to physical integrity and the ethical principle of autonomy and, hence, the ability of a competent adult patient to refuse treatment is still an issue of debate internationally. In South Africa aspects of this issue was revisited on the 30th of April 2015 in the Gauteng High Court which declared it was legal for Robert Stransham-Ford to ask a medical practitioner to help him end his life and, in doing so, taking into consideration Robert Stransham-Ford’s rights to dignity, physical integrity and his autonomy. Stransham-Ford refused medical treatment in the form of sedatives because he wanted to die while he was aware of his surroundings. The judgement was a victory for many amongst them are those who advocate for patient autonomy and patient’s rights to reach their own decision regarding their medical treatment, including the right to refuse treatment. (Nienaber & Bailey, 2016).
With reference to the case above which highlights, the medical practitioner’s most important ethical duty and legal obligation to respect the autonomy and physical integrity of their patient: not only in not compelling that patient to undergo medical interventions when they decide rather to die with dignity, but also in not coercing a patient to undergo other medical interventions against their wishes. Therefore, it is not in the constitution that a patient has the right to refuse treatment .However, it is there in section 12(2)(b) that they have a right to physical integrity which is the foundation in which the theory of patient autonomy and the right to refuse treatment are based on. The right to physical integrity is the same as the right to make decisions about your own body without anyone getting in your way . (Nienaber & Bailey, 2016).
In my experience in clinical practice since last year I have had a fair share of patients who refused treatment and the main reason is because they are In pain or they are tired. The first thing that comes to mind is education. I educate the patient on the importance of the exercises be it chest physio or just mobilisation I educate them on how it’s going to help them so that they still refuse and they are well informed. Further, I’ve learnt the concept of adapting treatment making it a little bit easier for example if your goal was to walk with the patient corridor length you resort to marching on the spot.
However, in a recent episode I had a patient with a thoracotomy for lobectomy of the left upper lobe. The patient was cooperative on our first session and it was effective, but on the second session the patient refused even to do anything because she was in too much pain. I explained to her that she will develop infection on her lungs due to the retainment of secretions if we don’t do the chest exercises and she knew them because we had done them the previous day. I went to her after she had received pain medication and patient still refused. I reported this to my clinician and she asked me if the patient is reliable patient because patients sometimes exaggerate their pain and if they are a reliable patient they are probably really In pain so I can ask the sisters if they can give her pain medication again.
All in all in clinical practice you are almost not given the option to not treat a patient because they refused treatment but they were stable and there were no contraindications to treatment. You must always adapt your treatment or if it’s pain you can go to them after they have received pain medication. After having read the literature I understand why they don’t give us that option, because them refusing can only make things worse. In the article I referenced above it says the right to integrity is the foundation on which the right to refuse treatment by a competent adult is based. The word competent means they must have valid reasons and that their decision must be informed. Therefore if a patient refuses treatment they need show you that they are knowledgeable on what refusing treatment entails. Like in the Stransham-Ford case he was aware that medical treatment would lead to him dying unaware of his surroundings.
References

Nienaber, A & Bailey, K. (2016). The right to physical integrity and informed refusal: Just how
far does a patient’s right to refuse medical treatment go? SAJBL, 9 (2). 73-77