Every patient has the right to; a healthy and safe environment, participate in decision making, access to health care, knowledge of one’s health insurance, choice of health services, confidentiality and privacy, informed consent, refusal of treatment, be referred for a second opinion, continuity of care and complain about health services (Kznhealth, 2013).

According to The Human Rights Act of 1998 (British Medical Association, 2000) every patient has the human right to refuse treatment, however this right goes hand in hand with another patient right—the right to informed consent. A health care professional must obtain the patient’s consent in order to treat them and by obtaining this consent it demonstrates to the patient that the health care professional respects the rights of that patient. A patient should only consent to medical treatment if they have sufficient information about their diagnosis and all treatment options available to them, which needs to be carefully explained by the health care professional in terms the patient can understand (Torrey, 2017). Once a patient has been sufficiently informed about the treatment options offered by the health care professional, the patient has the right to accept or refuse treatment. Whereas if a health care professional disregards the patient’s human rights, with regards to their treatment plan, based on their own personal beliefs or theoretical knowledge, this would be seen as unethical and illegal (Torrey, 2017).

The human right to health has many aspects. On the one hand, it entails that as health care professionals it is their duty to protect the health of individuals. On the other, it includes patient decision making regarding personal health, an idea which is closely linked to the right to autonomy and the right to dignity (Hevia and Schnidrig, 2016). This understanding is why the informed consent of the patient and the patients right to make a choice according to her own values and beliefs should be honoured, even if the decision may seem brazen or irrational to the health are professional. However, when patients are incapable of providing informed consent, such as if the patient is unconscious or mentally incapable of making their own decisions then according to the Patients’ Rights Act in Argentina (2009) as amended by the Death with Dignity Act (2012), consent may be provided on the patients behalf by a patients close relatives, next of kin, or legal guardian if a patient is unable to provide informed consent themselves as well as permitting patients to set up instructions regarding health decisions to be made if they become terminally ill (Hevia and Schidrig, 2016).

I experienced a clinical scenario involving a patient whereby her human rights to refuse treatment where ignored. The patient sustained 3rd degree burns to her anterior neck, left and right upperlimbs and around her entire abdomen. She was currently in the general ward awaiting a skin graft for her upperlimbs, however the doctors would proceed with the procedure if the patient was not adhering to physiotherapy (getting FROM in both upper extremities). Unfortunately, the patient had been refusing treatment for the past week saying that she does not care if she does not have full use of her arms again and that we have no idea how much pain she is in. The patient was continuously refusing physical and occupational therapy every day and, on the ward rounds the following day, the doctors stated that if the patient was no longer adhering to the rehab, she cannot get the skin graft. However, at no time prior to the decision was it made clear that the physiotherapy should be stopped, therefore every day the routine was the same. The patient would allow me to assist her to move her fingers, wrists and lowerimbs however she would refuse to move her elbows or shoulders or sit over the edge of the bed or stand. Every day, I would have to call the clinician to assist me in trying to convince the patient to progress with the rehab and eventually after a lot of persuading form the clinician the patient would agree to try bend her elbows on her own only allowing us to give a little assistance. However, when the patient was about to give up at about 10 degrees of flexion the clinician would quickly give assistance and fully flex the elbow. The patient would scream and start crying in pain and refuse to continue and ask if she could get a pain killer after the session. Each day it was the same, the patient would start by saying no and eventually give into persuasion and say yes and then half way through would cry and refuse again.

In such a situation in can personally say that I do not feel it was not morally or ethically right to persuade the patient to receive treatment as I do believe the patient was changing her answer from no to yes on the basis that she did understand the implications of refusing physiotherapy treatment but more so just to get rid of us and be able to request more pain medication. I do understand where the clinician was coming from with regards to the implications of the patient not receiving physiotherapy at this time in her medical plan however it was starting to feel like the clinician was bullying the patient into accepting the treatment. I could see the anxiety on her fascial expression and the way the tears rolled down her face that she was in immense pain during physiotherapy treatment.

A day later the patient started refusing treatment altogether. She would not allow either us or occupational therapist to touch her even with persuasion, she would not allow the doctors to change her dressing unless she was under anaesthetic in theatre and would not allow the nurses to attend to her unless it was for medication for pain relief. The patient became more and more depressed and continuously told us that it was her body and her right to do with it what she likes and she was tired of being forced to do something that only caused her pain. She wanted to rather go home and continue care form her house where she had family around her who she trusted. The patient eventually became so depressed and her condition appeared to be getting worse, so as per her wishes she was discharged back home, with follow up appointments for dressing changes and physiotherapy. Her human right to refuse treatment was not adhered to and I felt that she had basically been pressurized into accepting treatment by us even though she had refused over and over again. The clinician had a discussion with one of the nurses and made a point of saying that perhaps if she had actually listened to the patient’s wishes and stopped trying to coercing her into following the treatment protocols she may not have regressed to that depressive state and may have consented to continue with at least the medical treatment. It made me think that perhaps there are times when it is acceptable to stop physiotherapy treatment and perhaps if we had thought about this earlier we could have done things a little differently for the patient.

In my opinion I feel the whole medical team should have consulted with each other a lot more and come up with an appropriate treatment plan for this patient together. However, in that situation everyone seemed to do what they thought was best for the patient from their side without consulting each other and without actually stopping to consider what the patient wanted. Furthermore, I do believe that the patient fully understood the benefits of physiotherapy as well as the implications of refusing treatment and going home and even with this understanding in mind she still refused the treatment. In such a scenario I do believe that the patient actually had the right to refuse the treatment because she understood the benefits and risks involved with treatment. I believe that if the patient had not been coerced into being treated she may have remained in the hospital and at the least continued with her medical treatment and may eventually have consented to further rehab at her own will with no coercion. After thinking about the situation, a bit more I do believe the patients definite ‘no’ at the beginning of each physiotherapy session was a clear indication that the patient only later accepted treatment so that we would leave her alone and give her more pain killers and not actually because she wanted to receive the treatment.
From this experience, it is clear that the patient’s right to refuse treatment was not being respected which to me is not morally or ethically correct. I am however now more aware in terms of when it is appropriate to continue to treat a patient and when it is unethical and immoral based on a patient informed consent and their human rights.

References
1. Committee on Medical Ethics, British Medical Association. (2000). Human Rights Act 1998. Available: http://www.cirp.org/library/legal/BMA-human-rights/. Last accessed 3rd October 2018.

2. Hevia, M and Schnidrig, D. (2016). Terminal Patients and the Right to Refuse Medical Treatment in Argentina. Available: https://www.hhrjournal.org/2016/10/terminal-patients-and-the-right-to-refuse-medical-treatment-in-argentina/. Last accessed 3rd October 2018.

3. Kznhealth. (2013). Patients’ Rights. Available: http://www.kznhealth.gov.za/medicine/medicine13.pdf. Last accessed 3rd October 2018.

4. Torrey, T. (2017). Do Patients Have the Right to Refuse Medical Treatment?. Available: https://www.verywellhealth.com/do-patients-have-the-right-to-refuse-treatment-2614982. Last accessed 3rd October 2018.