“The patient may refuse treatment to the extent permitted by law.”
Background
I decided to write this blog on human rights and informed consent. I’m specifically looking at the patient’s right to refuse treatment and how to deal with it as a student in clinical practice.
Recently in my orthopedic block I had a patient who received an exterior fixation of his right lower limb following a tib-fib fracture caused by a motor vehicle accident. I was assigned to treat the patient and the main goal of the treatment session was to mobilize him with an assistive device and prepare him for discharge. As I got to the patient, I explained him the purpose of the treatment session and he refused to received treatment as he was in pain and reported that he was not willing to walk on that day. This was challenging for me as it was my first time to have a patient refusing treatment and I did not know how to handle the situation. I reported the incident to my clinician who took care of the situation.
I decided to reflect on the incident and researched about the subject in order for me to learn the best way to deal with such events without violating the patient’s right.
Discussion
There are many reasons why a patient could refuse treatment. These reasons could vary from the physical condition of the patient (pain, discomfort,..) to religious beliefs/ practices (e.g Jehovah’s witness and blood transfusion). By law a patient has the right to refuse treatment but refusal of treatment should be an informed decision.
When a competent adult patient refuses treatment, for whatever reason be it rational or irrational, the health professional is bound to respect that decision otherwise the patient’s right will be violated. Although this decision has to be an informed refusal meaning that the patient must be able to know what he/she is refusing and the consequences of her decision. Daniel et al. (2012) proposed that informed refusal to treatment just like informed consent should be comprised of three elements:
The patient must be competent.
He or she must have sufficient information to be able to make a choice.
The decision must be made voluntarily.
It is our duty as health professionals to ensure that the patient take decisions that will benefit him/her while they are in the hospital therefore a patient’s refusal to treatment should only be respected when the patient has shown an understanding of the consequences of their decision and the health professional has explained all the benefit and purpose of the treatment. According to Daniel et al (2012), the patient should be involved in all decision making regarding their health. The practice of informed consent will prevent the therapist from violating the patient’s right in clinical practice.
Conclusion
In conclusion, I think it is important as a physiotherapy student in clinical practice to know how far we can go in terms of wanting to provide treatment to our patients when they don’t want to receive treatment from us. I believe it is easy to violate the patient’s right to refuse treatment in the hope to help the patient get better.
Watch YouTube video on informed consent in clinical treatment, click here
References
Daniel, H., Prochazka, A., & Fink, A. (2012). Informed consent for clinical treatment. Canadian Medical Association Journal, 184(5), 533-540. doi: 10.1503/cmaj.112120
2 thoughts on “What to do when a patient refuses treatment?(Human rights and informed consent)”
Hi Nathan,
Primarily I would like to commend you on a very interesting writing extract. The topic you chose to elaborate about is one that I hold dear, as I have had multiple clinical experiences in this regard. Patient non-adherence is a topic we as physiotherapy students and future registered therapists experience daily.
Personally I have realised that once you have covered all your bases, and tried everything you could, it leaves nothing else to do but to respect the patients’ ethical right to refusing treatment.
I have recently come across a quote which states that, “Whether you think you can or can’t, you’re right”, (“Henry Ford Quotes (Author of My Life And Work)”, 2018). The quote by Henry Ford expresses the significance of our belief systems and mental models. These components or “mindsets” shape our behaviour.
Timelessly I have experienced patients who act and perform to a certain standard in accordance to their beliefs. Hereby I would like to encourage you to continue as you have, it is also good to do introspection and identify if there might be a sense of miscommunication. I implore the fact that you introduced another component to the treatment by bringing in your clinician, yet should you experience another scenario in the future, do not become despondent.
To conclude, I understand that we see our patients’ potential and we want to see them flourish as we know the effectiveness of treatment. Though, I 100% agree with the literature you have shared, in addition to your personal reflection that we have to remember the rights of patients. Additionally we also need to identify the border between forcing an individual and metaphorically “pushing them” through being stern yet upholding ethical rules and regulations.
Hi Nathan
I enjoyed reading your piece overall regarding Human rights and informed consent, i liked how you were able to link a personal experience in which you encounted during your clinical practice.
You have raised a very important issue as im sure many of us have also found our self in and did not know what to do to deal with it.
In your discussion paragraph you mentioned reasons for patients refusal of treatment as well as informed refusal in which a patient will be able to refuse treatment which i found very insightful.
It may help you to take a look at a textbook article by Probst, 2018: Physiotherapy in mental health and psychiatry, which acts as a guide on the different perspectives, contexts and approaches across a variety of related patients. It also covers a wide variety of evaluation tools and treatment methods for specific syndromes.
Overall i think it was a well written piece, but it may also help at looking at literature that focuses on how to cope with such situations.
References:
Probst, M. (2018). Physiotherapy in mental health and psychiatry. Edinburgh: Elsevier.
2 thoughts on “What to do when a patient refuses treatment?(Human rights and informed consent)”
Hi Nathan,
Primarily I would like to commend you on a very interesting writing extract. The topic you chose to elaborate about is one that I hold dear, as I have had multiple clinical experiences in this regard. Patient non-adherence is a topic we as physiotherapy students and future registered therapists experience daily.
Personally I have realised that once you have covered all your bases, and tried everything you could, it leaves nothing else to do but to respect the patients’ ethical right to refusing treatment.
I have recently come across a quote which states that, “Whether you think you can or can’t, you’re right”, (“Henry Ford Quotes (Author of My Life And Work)”, 2018). The quote by Henry Ford expresses the significance of our belief systems and mental models. These components or “mindsets” shape our behaviour.
Timelessly I have experienced patients who act and perform to a certain standard in accordance to their beliefs. Hereby I would like to encourage you to continue as you have, it is also good to do introspection and identify if there might be a sense of miscommunication. I implore the fact that you introduced another component to the treatment by bringing in your clinician, yet should you experience another scenario in the future, do not become despondent.
To conclude, I understand that we see our patients’ potential and we want to see them flourish as we know the effectiveness of treatment. Though, I 100% agree with the literature you have shared, in addition to your personal reflection that we have to remember the rights of patients. Additionally we also need to identify the border between forcing an individual and metaphorically “pushing them” through being stern yet upholding ethical rules and regulations.
I hope this post serves you well.
Kind regards.
Lisa Langenhoven
Hi Nathan
I enjoyed reading your piece overall regarding Human rights and informed consent, i liked how you were able to link a personal experience in which you encounted during your clinical practice.
You have raised a very important issue as im sure many of us have also found our self in and did not know what to do to deal with it.
In your discussion paragraph you mentioned reasons for patients refusal of treatment as well as informed refusal in which a patient will be able to refuse treatment which i found very insightful.
It may help you to take a look at a textbook article by Probst, 2018: Physiotherapy in mental health and psychiatry, which acts as a guide on the different perspectives, contexts and approaches across a variety of related patients. It also covers a wide variety of evaluation tools and treatment methods for specific syndromes.
Overall i think it was a well written piece, but it may also help at looking at literature that focuses on how to cope with such situations.
References:
Probst, M. (2018). Physiotherapy in mental health and psychiatry. Edinburgh: Elsevier.