Right to Refuse Treatment - Research Paper Example

THE RIGHT TO REFUSE TREATMENT Introduction The right to refuse treatment is now well established for some kinds of patients, especially in cases ofpsychiatric treatment. Different states have adopted various procedures of addressing the right to refuse treatment and for the overriding of this refusal. Oregons administrative procedure for override depends on an evaluation by an independent examining psychiatrist. Every state has laws governing the right to refuse medical treatment and advance directives about this right. It is essential for nurses to ensure that they are familiar with the legislations of their state. There is a complex relationship between the right to refuse treatment and the right to treatment. The Right to refuse treatment includes the right to refuse involuntary hospitalization. (Godard, Bloom, Williams, and Faulkner, 1998) More often than not, Nurses find themselves in the front line when the situation arises to deal with patients that refuse medication or treatment. Evidently, a voluntary patient has the right to refuse treatment and must not be treated against his or her consent, with the exception being in situations in which the patient becomes actively to others or to himself. The right to refuse treatment is closely related to the rights of the Mentally Disabled Persons, and every Nurse is required to be familiar with the guidelines laid down in the laws of the State in which they practice, so that they can administer medications properly to committed patients as well involuntary patients. Within the last 30 years, there has been a shift in opinion concerning patients’ right to make their own medical treatment decisions. Currently, the law states that for health-care providers, their patients are to be the primary decision makers in all health care decisions that affect them. (Ciccone, Tokoli, Clements and Gift, 1990). In order for patients to make good decisions about such issues, they must be fully informed about their medical condition. True concerns as to what happens to one’s self are the informed exercise of a choice, and this entails the opportunity to knowledgeably evaluate the options available to the patient, as well as the attendant risks. (Cournos, McKinnon, and Adams, 1988) Some patients refuse treatment due to wrong or delusional thinking about their medication. Some others refuse treatment because of denial of the state of their illness. In some cases, refusals get overridden after being examined by an independent psychiatrist. The cost of such and override procedure is quite significant, both to the health-care system and the patient. Patients’ rights to refuse treatment Patients who possess the capacity to make decisions have the right either to refuse or consent to treatment, even in situations where the patient’s choice can result in his or her death. (Roth, 1982). It is now a well-established fact that every competent adult has the right to refuse unwanted medical treatment (Applebaum, 1988). Thus, competent patients can refuse to start medical treatment, terminate treatment that is already in progress. Such refusals are usually made in advance directives such as a living will. In cases where a patient is deemed incompetent at the time of treatment, then an advance written directive or the patient’s legal surrogate can make the treatment decisions for the patient. (Zito, Craig and Wanderlin, 1991) In this regard, health-care providers must adhere to the patient’s decision, and if they are unable to do so due to moral or other reasons, then there should be an attempt to transfer the patient to other health-care providers that will adhere with the patient’s directives. The United Nations definition of human rights involves those rights that are inherent in the human nature, without which people cannot function as human beings. Section 2(d) of the 1993 Protection of Human Rights Act defines human rights as the rights that relate to liberty, life, dignity and equality of individuals, as provided for in the Constitution or embodied in the international covenants and which can be enforced by the law courts. Ethical responsibility The right to refuse treatment involves ethical, as well as both legal issues. Patients have the right to refuse or discontinue treatment even if the treatment involves life support like respirator treatment, which can lead to death. There is an exception to this right, which is directed at pregnant women. In some parts of the United States, there are legislations in place that prevent pregnant women from ordering termination of life support or writing an advance directive to terminate life support. Nurses have the legal and ethical responsibility and obligation to obtaining treatment consent from the patient. The ethical obligations that relate to the patient consenting to treatment are dealt with in the Ethics standard of practice. This practice guideline provides an update to the guidelines provided in the Health Care Consent Act (HCCA) (Kleinman, 2003; Jonsen, Siegler, and Winslade, 1998) Nurses must use their professional judgment and common sense to determine whether a patient is capable of understanding the information provided. (Roberts, 1998) In some situations, for instance in the case of a patient who suffering from advanced dementia, or a young child, the patient is not likely to understand the provided information, and so it would be unreasonable to inform the patient that a substitute decision-maker will be required to make the medical decisions on behalf of the patient. Conflicting principles The principle of the sanctity of life is deeply ingrained in our culture and conflict resolution regarding the sanctity of life and the principles of autonomy is quite difficult. (Kuhse, 1987) In some situations, a competent adult patient may make medical decisions that have the potential to shorten his or her life. For instance, in the case of Jehovahs Witnesses who refuse a blood transfusion that can save the patient’s life the patient does not want to die, but is prepared to die because of his religious convictions. In the United States, this competent patient’s autonomy and right to refuse medical intervention will usually be respected. (Godard, Bloom, Williams and Faulkner, 1998) Assessing the decision-making capabilities of a patient is implicit in the doctor-patient interaction and usually requires no formal testing. This is because there patient is presumed to be competent. A patient’s refusal of treatment may however necessitate more stringent standards of patient competence in cases where the risk to benefit ratio is very favorable, although competent patients should not have treatments imposed on them while incompetent patients should not be allowed to suffer the harmful effects of their bad decisions. (Jonsen, Siegler, and Winslade, 1998) It is the responsibility of the health-care practitioner who is proposing treatment to assess the patient’s capacity to make decisions about his or her treatment. If the health care practitioner finds that a client is not capable of making treatment decisions, the law requires that the practitioner provides the patient with the necessary information about the consequences involved. This provision of information should be according to guidelines established by that practitioner’s governing body. (Velez and James, 1987) Attaining the right balance in issues relating to patients’ right to refuse treatment can be quite difficult, as there is no universally accepted definition of competence. The ability to communicate choices, understand information about a treatment decision and appreciate the situation and its consequences are among the legal standards commonly used. (Godard, Bloom, Williams and Faulkner, 1998) Advocating for patients Health-care practitioners do not have the authority to make treatment decisions for their patients, except in cases of an emergency in which there is no available authorized person to make such medical treatment decisions. Similarly, health-care providers do not have the authority to make a decision to consent to the admission of a client to a care facility, except in cases of a crisis. (Roth, 1982) Nurses who obtain consent for treatment from patients have a professional accountability to be satisfied that the patient indeed has the capability to give consent for treatment. Also, nurses are professionally accountable for acting as client advocates and for helping clients understand the information relevant to making decisions to the extent permitted by the patient’s capacity. It is imperative that health-care professionals consider the patient’s cultural and religious background in the provision of healthcare. Health and illness are culturally constructed concepts that frame people’s responses to diagnosis and treatment. Under the Mental Health Act 1983 a patient can be hospitalized, detained and given treatment against his or her wishes. The 1983 Mental Health Act also covers the rights of people while they are detained, how they can be discharged from hospital and what aftercare they can expect to receive. Conclusion There is a complex relationship between the right to refuse treatment and the right to treatment. The Right to refuse treatment includes the right to refuse involuntary hospitalization. More often than not, Nurses find themselves in the front line when the situation arises to deal with patients that refuse medication or treatment. Evidently, a voluntary patient has the right to refuse treatment and must not be treated against his or her consent, with the exception being in situations in which the patient becomes actively to others or to himself. The right to refuse treatment involves ethical, as well as both legal issues. Under the Mental Health Act 1983 a patient can be hospitalized, detained and given treatment against his or her wishes. Patients have the right to refuse or discontinue treatment even if the treatment involves life support like respirator treatment, which can lead to death. There is an exception to this right, which is directed at pregnant women. In some parts of the United States, there are legislations in place that prevent pregnant women from ordering termination of life support or writing an advance directive to terminate life support. Nurses also have the legal and ethical responsibility and obligation to obtaining treatment consent from the patient. References Applebaum PS, (1988) The Right to Refuse Treatment with Antipsychotic Medications: Retrospective and Prospective. AM K Psychiatry 145:413-419. Ciccone JR, Tokoli JF, Clements CD, Gift TE (1990): Right to Refuse Treatment: Impact of Rivers v. Katz. Bull Am Acad Psychiatry Law 18:203-215 Cournos F, McKinnon K, and Adams C (1988) A Comparison of Clinical and Judicial Procedures for Reviewing Requests for Involuntary Medication. Hosp Community Psychiatry 39:851-855. Godard, S. L., Bloom, J. D., Williams, M. H. and Faulkner, L. R. (1998), The right to refuse treatment in Oregon: A two-year statewide experience. Behavioral Sciences & the Law, 4: 293–304 Kleinman, Irwin (2003) The right to refuse treatment: ethical considerations for the competent Patient. American Journal of Physical Medicine & Rehabilitation, 82(2): 152-157 Jonsen AR, Siegler M, and Winslade WJ (1998) Clinical Ethics: a Practical Approach to Ethical Decisions in Clinical Medicine. New York: Macmillan. Kuhse H (1987) The Sanctity of Life Doctrine in Medicine: a Critique. Clarendon Pr, Oxford. Roberts, LW (1998) The ethical basis of psychiatric research: Conceptual issues. Official Journal of the American Psychopathological Association 132:37-43 Roth LH (1982) Competency to consent to or refuse treatment. The American Psychiatric Association Annual Review, Am Psychiatric Pr, Washington, 350- 360 Velez J, James WS (1997) Medicine Court. American Journal of Psychiatry 144:62-66. Zito JM, Craig TJ, and Wanderlin J (1991) New York Under the Rivers Decision. An Epidemiologic Study of Drug Treatment Refusal. American Journal of Psychiatry 148:904-90. Read More