Right of Decision Making

I have witnessed a “burned out” nurse simply say to a client who is refusing a medication due to a side effect the client does not care for, ‘okay, I will just put refused and tell the doctor.’ This client needs educated about his/her choice. Most of the time, the client does not realize how refusing the medication can have a negative effect on his/her body overtime.

Most decisions are made with analysis, but some are judgment calls not susceptible to analysis due to time or information constraints. Please write about a judgment call you’ve made recently that couldn’t be analyzed. It can be a big or small one, but should focus on a business issue. What was the situation, the alternatives you considered and evaluated, and your decision making process? Be sure to explain why you chose the alternative you did relative to others considered.

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)

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).

If an individual expresses that they want to discontinue their medication and becomes non-compliant with their medication then it is my role to identify the risk they are currently posing and update their risk assessment; inform their CMHT and let the citizen know of the consequences to them not taking their medication and reiterate that it is their choice, as long as they have all the information to make a decision (wise or unwise). It is important to emphasise that not all individuals understand information the same way, therefore I have found that the use of internet, booklets, music, audio recordings, talking group therapy and pictures can be applied to explain a situation to a resident if they are unsure of particular consequences to their health.

What happens if you come upon a patient that is being difficult and refuses to follow your directions? If I was I this situation, I would let the doctor

I must be aware, as the patient’s advocate, of the choice of each individual patient regarding his or her medical management or, as in this case, the withholding of treatment.

Good communication between physician and patient is vital for a patient to make an informed choice regarding their care.

All three providers have agreed that prescribing a pharmacologic and non-pharmacologic treatment regimen must result from clinical judgment based on a thorough assessment of the patient and the patient’s environment, present and past medical history, current home medication, the determination of differential diagnosis and appropriate diagnostic procedure, a review of potential alternative therapies and specific knowledge about the drug chosen and the disease process it is designed to treat (Woo & Robinson, 2016; p.6).

Unsuccessful patient transitions of care resulting in negative outcomes is a challenging clinical problem. The perception of a medical condition and how serious it can be can differ from person to person. Adequate education and intervention given at the appropriate time can make all of the difference when it comes to interpreting and receiving a clear understanding of the treatment plan. The consequences of not following a treatment plan properly causes patients to return to the hospital emergency room with complications, which can ultimately result in being readmitted for the same diagnosis. These readmissions, which are virtually preventable, can cost patients and insurance companies

Patient's decision-making is influenced by several factors. Patients may change their decisions, from accepting or refusing treatment depending on the available treatment options. The capacity of the individual to make informed medical decisions can differ as the patient's status changes cognitively, emotionally, and/or physically and as the proposed treatment interventions change. Treatment refusal is a common situation faced by clinicians. Patients do not usually refuse the medical advice if the advice is of good intention. When patients refuse an advice, it indicates some underlying reasons related to the patients or family, factors associated with the physician as well as social and organizational issues.

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).

The first step of the Ethical Decision-Making Procedure is stated as, “1.0 Become Aware of Dilemma” (McNamara). According to the given case scenario, the dilemma is clearly stated. It reads that the client (mother) does not believe in rewards or support the use of them for her son. The mother is going against what the BCBA believes in and stands for, thus causing a direct dilemma. Removing reinforcers is not feasible for the professional BCBA, and this must be properly addressed with the client. Situations like these are where the Ethical Compliance Code comes into place for the sake of the clients and professionals involved.