One of the most common things that medical professionals experience in a clinical setting are patient’s refusal of treatment after given informed consent. Informed consent involves explaining the procedure of the assessment and treatment of the session given at that time (Torrey, 2018). After the patient has understood what will be done, then they can determine whether they want to accept it or refuse it. Patients have the right to refuse treatment and it is the professional’s responsibility to respect that choice (Kleinman, 1991). Although, the right to refuse medical treatment is universally recognised, this right is not always honoured. Therefore, patients who have altered mental status, who are children and who are considered a threat to the community have no legal ability to refuse treatment (Torrey, 2018).
Due to the fact that each case scenario is different, therefore, it requires different ethical considerations (Kleinman, 1991). It is up to the physician’s morality and ethical values to determine what they think is the right thing to do.
Based on one of my experiences, patient A was an elderly female who refused physiotherapy treatment because she felt “unwell” but never explained why she felt that way. It was later discovered that she had some financial issues at home which caused these disruptions. I tried to encourage her and advise on the importance of physiotherapy but she still continued to refuse treatment. I went to speak to the physiotherapist in charge and explained the situation. The therapist replied that the patient needs to be seen because the hospital is full and patients need to be discharged as soon as possible. After hearing this, I questioned what was the right thing to do? If I obeyed the therapist’s suggestion and treated this patient, even after they have refused treatment, have I actually respected the patients’ right? Does that make me a professional therapist? According to Al-Rubaish (2010), professionalism deals with aspects such as altruism, respect for others, human qualities (for instance, empathy), honesty, integrity, ethical and moral values, accountability, excellence, communication and collaboration. If I treated this patient, then I did not meet the requirements of being a professional, because I have disrespected her rights. However, if I choose not to treat the patient, even though I know the treatment is beneficial for the patient, I may be seen as an incompetent physician. Due to the fact that was the patient competent (mental status) to make this choice? Should I have explored more on why she felt unwell, was it a home situation, emotional status etc. I could have spoken to the multidisciplinary team and see where we can help her (Kleinman, 1991). For instance, I could have spoken to the social worker and see where we can help and progress this patient. We need to view and treat the patient holistically.
In this instance, we will try and convince the patient to agree with treatment because we know the benefits of it. However, we are not just treating because we want to discharge her but we are treating because we actually want her to get better and return to function.
There are other examples given in this article including what the ethical considerations are.
As mentioned earlier, all patients have the right to refuse treatment and we need to respect that choice. However, we also know that each case presents differently which requires us to look at each case with different ethical considerations (Kleinman, 1991). Nothing in life is straight forward, black and white. We need to look at the case, analyse it and then conclude on what is the ethical thing to do in this particular situation.
“Ethics is nothing else than reverence for life.” -Albert Schwertzer
What I have learnt from our ethics class is that there will always be 2 solutions for one problem. The one solution will be more ethical than the other. However, the decision we make is based on our moral values, beliefs and how we view certain aspects. As medical professionals, our decisions are based on benefiting the patient’s function and outcome. Therefore, for future practice, we need to keep these considerations in mind. We need to think logically to formulate an ethically accepted decision, the next time our patient refuses treatment. It is also important to remember to consider all aspects of the patient before making a decision. If need be, we must speak to the relevant professional to holistically treat the patient.
References:
- Al-Rubaish, A. (2010). Professionalism Today. Journal of Family & Community Medicine, 17(1), 1-2.
- Kleinman, I. (1991). The right to refuse treatment: ethical considerations for competent patient. Canadian American Association Journal, 144(10), 1219-1224.
- Torrey, T. (2018, April 8). Do patients have the right to refuse medical treatment? Retrieved from Very Well Health: https://www.verywellhealth.com/do-patients-have-the-right-to-refuse-treatment-2614982
5 thoughts on “Human Rights”
Good daay Michelle
The right to refuse treatment is always an issue that needs in-depth investigation, because a lot of factors can influence the decision just like you mentioned on your post about patient A’s financial issues. However, as a therapist, you always need to protect yourself, which could be done through reporting to senior staff and documenting on the folder. Reporting to the senior physios was a good move, and that showed that you wanted to fulfill your role as a therapist and provide therapeutic services but was hindered by the patients refusal to treatment.
In most cases, the patients forget that even though they have rights, they also have responsibilities they need to abide to, for example ‘responsibility to comply with prescribed treatment or rehabilitation procedures,’ please read up on patients responsibilities.
I enjoyed the fact that you engaged the reader by asking question, which the reader can try to answer, and you picture fits/supports your piece. Your piece is easy to read, and is grammatically correct. I have always heard about working as a multi-desciplinary team but has never really put it into practise, for me your thinking about involving the social worker to help out in the situation, really stood out, and reminded me that as physiotherapists we need to engage with other teams as well for the whole being of the patient. Your referencing format was correct as well.
Just look up on the patients responsibilities, which you could have used to explain to the patient that even though they have the right to refuse treatment but they also need to abide to the responsibilities that accompany the rights.
Thank you for your feedback. I definitely will go read up and brush up on what the patient’s responsibilities are.
Hi Michelle,
Your writing piece is something that I find so relevant as a student. We are constantly put in situations, as you have mentioned, where the patient wants one thing but our superiors expect something else.
There has been many occasions where patients refuse treatment. This could have been due to pain, emotional reasons, mental status, or even just stubbornness. As students, we are constantly expected to report back to our superiors on how our patients are doing and how treatment sessions have been. More often than not I have found myself, and observed other students, being reprimanded for ‘allowing’ patients to refuse treatment. We are encouraged to make clinical decisions using professional reasoning on a daily, but once we have done all the persuading and confirm that a patient is still reluctant and refusing treatment, we find that we are still in the wrong.
I like how you mentioned what you could have done better in the situation as you look back. I especially agree with the concept of approaching the multidisciplinary teams (MDT.
By interacting with the MDT, we as professionals learn to treat patients holistically. This means taking all aspects of he patient, including physically, psychologically, socially, and spiritually, into consideration when treating them( Huljev & Pandak, 2016).
According to Clark (2013), working with a multidisciplinary team facilitates earlier discharge to the home, increases the likelihood that patients will regain independence in activities that support daily living, and results in fewer patients requiring long-term institutional care.
I am lucky to be at a placement where this time of work environment is highly encouraged. We are expected to call on other team members and communicate issues regarding patient care, especially if another team member may have better knowledge with regards to an issue we may be facing. In many cases, the social worker or even doctors have the answers we may be looking for.
We do not always realise the importance of communication when it comes to patient care. I love how you chose to highlight an holistic approach when it comes to these situations. Sometimes it makes difficult and confusing patient scenarios so much easier to understand and manage.
References:
Huljev, D., & Pandak, T. (2016). Holistic and team approach in health care. Signa Vitae – A Journal In Intensive Care And Emergency Medicine, 11(Suppl 2), 66-69. doi: 10.22514/sv112.062016.14
Clarke, D. (2013). The role of multidisciplinary team care in stroke rehabilitation. Progress In Neurology And Psychiatry, 17(4), 5-8. doi: 10.1002/pnp.288
Thank you for your feedback, Saarah. I think many times we forget about the other professionals that also play a major role in getting a better outcome from the patient. Although we are constantly reminded to work as team, we always somehow forget. However, I do hope in future practice, that we do not forget about them and that we refer the patient to necessary professionals.
Hi Michelle
Your piece is easy to ready with no grammatically errors.
At the beginning of your piece you talk about one of the most common things that medical professionals experience in a clinical setting which is the patient’s refusal of treatment after given informed consent. However your clinical experience is about the patient who refuse treatment due to her personal issues and not because of the informed consent. I would have liked it if you brief us about the medical professionals and patients refusing treatment due to personal issues.
Going through your piece i like how you have done the self introspection and actually tried to find the solution to the problem you experienced. This also taught me how i should react in future if it happens i experience the same situation.
Thank you for sharing this piece