A patient’s right to choose – Gillian Cloete
As a physiotherapy student and being in a clinical setting, I have been faced with the situation whereby patients have been in therapy sessions with a therapist against their will; sometimes this said therapist was me. In a clinical setting, especially a rehabilitation clinical setting or placement, where patients are expected to participate in the rehabilitation programme the patients often times would not feel fit for therapy or would refuse treatment for whichever reason they present with and it is in such instances where the clinician would give the patient therapy although they have already mentioned they are not fit for it. In the cases where the therapist who goes against the patient’s wishes is myself, I was often times told that the patient does not have a choice as they are at a rehabilitation placement thus they have to partake in therapy; in the instances where patients stand by their decision to refuse therapy, the clinician indicates that failure to comply with therapy will lead to the discontinuation of therapy. This lead me to my ethical dilemma questioning how much a patient’s right to refuse therapy truly matters and what their rights are as patients when it comes to accepting or declining treatment.
According to the Health Professions Council of South Africa (HPCSA) : Guidelines for Good Practice in the Health Care Profession (2008), lists the rights of patients whereby the rights highlighted for the topic of this assignment include: patient’s right the participation in decision making, informed consent and refusal of treatment. In terms of the right to be involved in decision making, every patient has the right to be involved in the development of health policies as well as the right to participate in making decisions about their own health and health care. Informed consent gives the patient the right to access to accurate knowledge surrounding the nature of the diagnoses, treatment of the diagnosis and the risks involved in the diagnosis and treatment. The main right of a patient is the refusal of treatment; the patient has the right to refuse treatment whether the refusal is verbal or in writing and the refusal of the patient stands unless it endangers the health of others.
The rights highlighted above are yet but a few of the patient’s rights but from those rights it can clearly be marked that a patient does have rights surrounding how they are treated and the refusal of the said treatment. The patient has the right to make an informed decision and decline treatment; I think these rights go hand in hand as a patient can make an informed decision on treatment once they have the necessary tools to make such a decision. Every patient who refuses therapy is within their rights and together with the right to have accurate knowledge about their diagnosis and treatment can make an informed choice about whether or not to refuse treatment.
Although I now know the rights of the patient, the ethical dilemma remains. As a student we are given as much rights as a patient about whether or not we would like to commence treatment but just as a patient’s rights have been violated by the therapist doing treatment against their will our right to refusal has been violated too. The choice standing at the moment is whether or not I follow ethical principles and accept the patients refusal or whether or not I get removed from a clinical rotation as I have failed to treat the patient given to me.
References:
Health Professions Council of South Africa: Guidelines for Good Practice in the Health Care Professions. National Patients’ Rights Charter, booklet 3. 2008.
3 thoughts on “A Patient’s right to choose”
Hello Gillian,
Thank you for allowing me to read your piece on a patient’s right to choose. It was very interesting to read how patients are refusing treatment and how the clinicians force you as physiotherapy student to treat these patients. I can imagine as you explained this allows you to become part of a very difficult and unconformable situation. Your writing piece matches the topic’s we discussed in class and therefore I will rate the content as good. This piece makes me think about my own clinical practice. Some of my patients’ refuses treatment and it puts me in a difficult situation because I know that they would benefit from the treatment but on the other hand they have the right to say no. What can one do in that situation? It is always good to think about the situation from the patient’s perspective. Consider adding why patients are not feeling fit for treatment. This will add more content to the claims made.
The argument made about patients refusing treatment and clinicians forcing physiotherapy student to go against the patients’ rights was well structured. It was easy to grasp that this is an ethical dilemma that you are faced with and probably future physiotherapy students will be faced with as well. I agree that it does not matter what you chose to do you will be doing something wrong in either the patients or the clinicians’ eyes. The argument was made based on knowledge due to the reference added from HPCSA that patients have a right to refuse treatment. Consider making the argument stronger by adding facts where students got removed from a clinical rotation or got bad marks due to a similar situation.
By adding the reference from HPCSA to the writing piece made your argument stronger. HPSCA as stated is the Health Professions Council of South Africa and is therefore a good source to reference. The referencing is correct according to the APA-style. Consider adding more references about the other side of the ethical dilemma, the students’ side where we are given as much rights as a patient about whether we would like to commence treatment.
Overall, your writing piece touches on a real ethical dilemma that all students will encounter and therefore I enjoyed reading it. The paragraphs are well constructed and easy to read. Throughout the piece consider using concise language by replacing “whether or not” by whether.
A few grammar errors that I have noticed:
First paragraph:
– Fourth sentence: Replace lead with led
Second paragraph:
– First sentence: Remove space between “(HPCSA) and :”
Last paragraph:
– Third sentence: Use concise language and change “at the moment” to “now”
– Third sentence: change patients to patient’s
Thank you and all the best
Megan
dear Gillian. thank you for sharing your experience with us. it was a very interesting piece and I enjoyed reading it. I truly think your writing piece was very relevant as I myself am often caught in this ethical dilemma and I think many of us as students are. I like the fact that you have explained what happens in your block to give a clearer and more realistic understanding of the situation. your piece is referenced well and has good, relevant facts. Your argument is strong as it creates a dilemma between right and wrong , and what is expected of us by clinicians despite our rights, or the rights of patients. your content is strongly related to the topics discussed in the module therefore it is good.
your piece is well and correctly referenced, therefore it can be rated good, although you might want to consider adding some more references from the students side that could make your argument stronger example expectations of clinicians from students that could lead to unethical behaviour, or examples of students or the amount of students that were removed from block, because they chose to be ethical.
I see Megan already corrected some grammar errors, therefore I will not do it again.
lastly, I really enjoyed your piece, best of luck!
kayelene bezuidenhout
Hi Gillian
Thank you for sharing your piece with us. I think that this topic is something we all can relate to, as it seems to be a big problem amongst the students on clinical blocks. I have been in similar situations where there were differences in opinions whether or not the patient still needs to be treated after they refused treatment. As students I know it can be difficult as we strive to pass each block with good marks and being removed from a block due to not treating a patient who refused treatment, is something none of us want.
Your text reflects the topics we discussed in class and I believe that it is really important to respect a patient’s decision they make regarding their own health. The reference you have included supports your writing well and states that the patient have the right to refuse treatment. I suggest that you add more references to make your piece even stronger and to support the statement of patients having the right to refuse treatment.
Another suggestion is that you might consider using shorter sentences. For example: “In a clinical setting, especially a rehabilitation clinical setting or placement, where patients are expected to participate in the rehabilitation programme the patients often times would not feel fit for therapy or would refuse treatment for whichever reason they present with and it is in such instances where the clinician would give the patient therapy although they have already mentioned they are not fit for it.” Try to break this sentence up and changing it in two sentences. It will make it easier to read your piece and increase the flow of it.
I really enjoyed reading your draft and look forward to your final piece. Good luck with all the assignments and rest of block.