Should an Incapacitated Patient’s Refusal of Treatment Be Respected? Discussion of a Hypothetical Case
Eubios Journal of Asian and International Bioethics 25 (4):112-118 (2015)
AbstractIn the present super-aging society, issues concerning what treatment should be given for incapacitated patients have become more important than ever before. This paper discusses whether or not an incapacitated patient’s refusal of treatment should be respected. The authors present a complete hypothetical scenario involving a 75-year-old moderately demented man suffering from malignant lymphoma. Of primary importance are the respect for patient dignity and the protection of human rights. Acts such as coercion, disregard, restriction, and surveillance can be unethical in many situations. The effectiveness of chemotherapy for malignant lymphoma and its adverse outcomes could offset each other, leaving no net benefits for the patient. The patient is vulnerable and this very vulnerability requires the utmost protection and care. However, protection must be sensitive and comprehensive and the protection of his life at the expense of many other valuable factors is not justifiable. Coercing unwanted treatment would be intrusion, not protection, because of the physical and psychological suffering. When the refusal is explicit, consistent, and stable enough, it should to be viewed as true and current desire. Due to moderate dementia, the patient has lost his rational capacity, but his emotional capacity remains. If the remaining portion of his personality is rooted in his feelings, these feelings should be respected as much as possible. Those involved in the care of the patients who refuse treatment should not force them to undergo it simply on the grounds that it may be an established standard in their own country. What must be asked first is whether or not forced treatment would promote the patient’s subjective well-being. Additionally, treatment decisions should not be distorted due to the selfishness or discriminatory feelings of those involved in his care. In situations in which patients lack decisionmaking capacities, overriding the patients’ refusals of treatment should be regarded as an exception, rather than a standard course of action. Even in patients who are incapacitated, treatment refusal could stem from the feelings of the individual. Their subjective wellbeing would not be improved through close observation, restraint, denial, and coercion, the purpose of which they does not understand.
Similar books and articles
Treatment Decision Making for Incapacitated Patients: Is Development and Use of a Patient Preference Predictor Feasible?Annette Rid & David Wendler - 2014 - Journal of Medicine and Philosophy 39 (2):130-152.
Use of a Patient Preference Predictor to Help Make Medical Decisions for Incapacitated Patients.A. Rid & D. Wendler - 2014 - Journal of Medicine and Philosophy 39 (2):104-129.
Law, Ethics, and the Patient Preference Predictor.R. Dresser - 2014 - Journal of Medicine and Philosophy 39 (2):178-186.
Decision Making Capacity Should Not Be Decisive in Emergencies.Dieneke Hubbeling - 2014 - Medicine, Health Care and Philosophy 17 (2):229-238.
Physicians' Evaluations of Patients' Decisions to Refuse Oncological Treatment.T. van Kleffens - 2005 - Journal of Medical Ethics 31 (3):131-136.
Competence, Practical Rationality and What a Patient Values.Jillian Craigie - 2011 - Bioethics 25 (6):326-333.
Patient Informed Choice for Altruism.M. D. Doukas, David J. & John Hardwig - 2014 - Cambridge Quarterly of Healthcare Ethics 23 (4):397-402.
Best Interests and Treatment for Mental Disorder.Phil Fennell - 2008 - Health Care Analysis 16 (3):255-267.
Relatives' Knowledge of Decision Making in Intensive Care.M. G. Booth - 2004 - Journal of Medical Ethics 30 (5):459-461.
Refusal of Treatment and Decision-Making Capacity.S. -L. Bingham - 2012 - Nursing Ethics 19 (1):167-172.
Rationality and the Refusal of Medical Treatment: A Critique of the Recent Approach of the English Courts.M. Stauch - 1995 - Journal of Medical Ethics 21 (3):162-165.
Making Decisions About Life-Sustaining Medical Treatment in Patients with Dementia.Arthur R. Derse - 1999 - Theoretical Medicine and Bioethics 20 (1):55-67.
False Belief and the Refusal of Medical Treatment.R. Faden & A. Faden - 1977 - Journal of Medical Ethics 3 (3):133-136.
“I Would Prefer Not To”: Assessing Competence to Consent in a Case of Refusal of Cancer Treatment.Gustavo B. Castellana, Lilia B. Schraiber, Talita R. de Oliveira & Daniel M. de Barros - 2019 - Clinical Ethics 14 (1):42-45.
Added to PP
Historical graph of downloads
Citations of this work
No citations found.
References found in this work
Whose Justice? Which Rationality?Alasdair Macintyre - 1988 - Journal of Religious Ethics 16 (2):363-363.