William Yang

I.

Treatment Refusal
a. If patient can consent to treatment, patient has a right to refuse
b. Healthcare has advanced to the point where you can sustain life
indefinitely
i. At times, this treatment can be torturous
ii. Ethical issue: Beneficence vs Non-maleficence
1. In many cases, top priority: maintain patients comfort
and dignity
c. Religious Values
i. If patients are capacitated, they can refuse treatment on the
basis of their religion, even if it seems irrational must take into
ii. Does not apply if they are demanding treatment
iii. Clinicians cant justify overriding a patients refusal based on the
outcome
iv. Furthermore, clinicians cant justify overriding a patients refusal
just because the patient shares different beliefs and values
they are free to be dumb if they are capacitated
d. If patient is incapacitated (see previous lecture for criteria) need
surrogate
i. Surrogate must properly represent what the patient would have
wanted. For example, atheist parent cannot be a surrogate for
an incapacitated patient who is a Jehovahs Witness
e. Patient needs to provide a valid reason after refusing treatment
f. When clinicians can override refusals:
i. Life threatening, emergency situations (when the patient is
incapacitated and dying)
ii. If other lives are at stake (pregnant women, patients with
dependents, etc.)
iii. The most important factor to consider whether or not to override
is the patients capacity. Clinicians should not try to deem the
patient incapacitated in order to override a refusal
g. Clinicians can also refuse to treat a patient
i. As long as if its in the patients best interests
ii. If theres a moral motivation
iii. If treatment will cause more harm to others (refusing organ
transplant to very unqualified people)
iv. If it wont work (giving medicine to hypochondriacs)
v. If the treatment is very likely to be unsuccessful
vi. If the treatment will lower the patients quality of life overall
h. Clinicians should never completely abandon patient can withdraw
treatment, but must try to benefit patient in every way possible (if
refusing a treatment on moral/belief grounds, physician can refer the
patient to someone who will offer the treatment)