Patient Refusal

Although the authors agree with Katz on his view of sense one and sense two, they reason that his model of shared decision making is nothing like informed consent. Shared decision making is when the doctor and the patient reach a conclusion that satisfies them both, but the authors do not agree with this notion because it violates the idea of informed consent by involving the doctor’s opinion. In sense one, the second condition states there should be no manipulation or coercion in true informed consent, and shared decision making does not recognize

Informed consent is the basis for all legal and moral aspects of a patient’s autonomy. Implied consent is when you and your physician interact in which the consent is assumed, such as in a physical exam by your doctor. Written consent is a more extensive form in which it mostly applies when there is testing or experiments involved over a period of time. The long process is making sure the patient properly understands the risk and benefits that could possible happen during and after the treatment. As a physician, he must respect the patient’s autonomy. For a patient to be an autonomous agent, he must have legitimate moral values. The patient has all the rights to his medical health and conditions that arise. When considering informed

Rarely any physician intends to harm patients when he or she provides treatment to them. Patients see physicians and specialists in full faith that they will get help with a condition. What complicates the patient-doctor relationship is that the outcome of each patient’s treatment is different because of individual health conditions and the course of treatment chosen by the doctor. Problems arise when a patient is not satisfied with care provided by the doctor or in extreme cases when a patient dies. Since most of the time it is hard to clearly determine whether the outcome was solely a result of the course of treatment chosen by the doctor or whether other factors played a role too, quite often patients take their

nutrition, hydration and pain relief? Advance decisions to refuse treatment are not as yet widespread in medical care, but are undoubtedly encountered more frequently (Cowan 2007).

Another issue with the implementation of Informed consent arises when the patient waives the right to Informed consent and leaves the right to make the decision on the physician. Though legally correct, this can cause psychological stress for the physician especially when the decision is about a life threatening medical condition. Moreover, this also makes the patient vulnerable to abuse. (Manthous, DeGirolamo, 2003)

Patient informed consent refers to the situation where the patient is fully informed on the consequences of their health care decision after which the patient gives the decision. For there to be informed consent, there are five elements that must be discussed. The first is the nature of the patient's decision then the applicable alternatives to the proposed intervention. Third are the risks, benefits and uncertainties associated with each of the alternatives. Fourth is the assessment of the patient's understanding and last is the acceptance of the intervention or an alternative by the patient. Before the patient's consent is considered to be valid, the patient's competency to make the decision must be addressed. The criteria for evaluating the patient's competency is clearly stated in section 3 of the 2005 Mental Capacity Act which states that provided the person is able to understand, retain and use information provided and to communicate their decision in any way such as talking or sign language, they are competent to make a decision. If a patient is treated against their refusal to consent, it amounts to the tort of battery or can also be considered the crime of assault. In addition to this, laws that touch on human rights reinforce the importance of the protection of the physical integrity of the individual in terms of their right to respect of their private life. Therefore, refusal of medical treatment is a human right.

Every patient has a right to decide on their own course of treatment and freely consent to that treatment. In order to make an educated decision they must be provided with the proper information to make an informed choice (Opinion 8.08 - Informed Consent, 2006). It is the physician’s legal and ethical obligation to provide this information when making their recommendation on treatment. The choices given must be in accordance with good medical practice (Opinion 8.08 - Informed Consent, 2006). The informed consent is the legal policy, either written or verbal, that gives full disclosure of all the information including potential risks that is applicable to the patient’s condition and treatment being offered (Kazmier, 2008).

This assignment will critically analyse and justify the decisions based around a fictitious patient using a clinical decision making framework highlighting its importance to nursing practice. The chosen model will demonstrate clinical decision making skills in the care planning process. The patient’s condition will be discussed in-depth explaining the pathophysiology, social, cultural and ethical issues where appropriate in the care planning and decision making process. Any vulnerability that the patient may experience will be discussed and dealt with in the care planning and decision making process. The supporting evidence based literature will be analysed and

Some of the factors that patients do not adhere to when their healthcare provider tells them too is due to patients being too busy. Often times life is very busy as we all know this but forgetting to take of yourself can have detrimental effects to your health. Some people think they can get better on their own without the help of a doctor so they feel like they will be fine or able to handle any health complication on their own. Another reason is that often people do not understand or they forget what the doctor is telling them about their prescribed treatment regimens and other patients decide to simply not follow it. As stated in the article by Sklar, Min Sen Oh & & Chuen Li, 2008 “Poor communication with healthcare providers was also likely to cause a negative effect on patient’s compliance (Bartlett et al 1984; Apter et al 1998)”. Miscommunication between a doctor and patient is at the root of most adherence problems. Often times patients leave their doctors office not knowing or having the slightest clue to what they should be doing. Instead of asking for help or clarity they just leave. Communication needs to be clear and effective for both the patient and the doctor. Non-adherence is wide spread when it comes to patients not adhering to what professionals tell them. Many patients will have significant risks because they forget,

Informed consent is an integral part of the medical process, but what is it? How can the principles of Informed Consent conflict with each other or with patient care? It is important to examine Informed Consent very carefully and explore how the principles of Beneficence and Patient Autonomy work with each other for the best interests of the patients, even if the patient is refusing some treatment that is important in the standard of care. However, it may be possible that Informed consent and these elements work against one another, and conflict with the best interests of the patient.

I agree with Dishman's statement that most patients, myself included, are passive patients. In many of my health care classes, we have talked about the patient versus provider roles, this is called Paternalism. According to PubMed, "paternalism is described as a dominant attitude of one over another. It was widely practiced years ago because clinicians were expected to make the best decision for the patient (Gallagher, 1998)." Basically, if a doctor said to do something, you did it, no questions asked. In recent years, this model has changed and more people have started questioning their doctors decisions and becoming more informed. I believe this has since changed with the implementation of informed consent. This means that the patient must fully understand what they are agreeing too. As a health care professional, I believe asking the patients if they have any questions and explaining everything as well as I can will help them become active participants.

Patients in the United States have a right to refuse care if treatment is being recommended for non-life-threatening illnesses according to the Washington School of Medicine (2012). The simple task of refilling a prescription, or choosing to not get a flu shot are all acts of not following through with treatment mechanisms. Patients often times refuse medical treatment for far more reasons than just religious beliefs. Subconscious emotion reasons about side effects, pain, healing time, and the procedure itself scares patient’s away (Washington School of Medicine, 2012).

As peoples’ beliefs are susceptible to systematic biases (ref.), physicians need to provide guidance not only about the actual decision, but also about common errors in peoples’ thinking (Kahneman et at al., 1993). The physician is thus acting in the dual role of informer (of information) and advisor as to what action (or inaction) the patient should subscribe to next. This dual role is made even more difficult by the need to effectively elicit the patient’s preferences and integrate them into the process (ref.).

The situation in scenario 1 could leave a patient very disappointed due to lack of effective communication.

Even if patients cannot understand and make true choices, they have relatives such as family or spouse; hence, doctors can tell the truth to their relatives. Therefore, since doctors can simplify their explanations and patients’ family can make choices for them, doctors should always tell the truth.