Patient Right to Refuse Treatment

            The law recognizes the right of the patient to refuse medical treatment. This right includes the refusal of life-saving treatment, which could lead to death. The expression of a patient’s refusal could be made either before the administration of the treatment or at a prior and advanced time, well ahead of future incompetence (Michalowski, 2005).

            The recognition by the law of the patient’s right is so strong and resolute, such that the disregard of the patient’s wishes through the administration of medical treatment despite his refusal would amount to battery (Michalowski, 2005).

            The above explained recognition by the law on the patient’s right to refuse medical treatment reflects the policy of the law to recognize the autonomy of patients, which stands on a higher footing than the interest of the state to protect the life and health of its citizens. However, this does not mean that the state abandons its duty to protect its citizens’ lives. Patient autonomy would only be respected if it shows competence to decide on the part of the patients. The reason behind this policy is that “the principle of the sanctity of human life must yield to the principle of self-determination (Michalowski, 2005).”

            One issue regarding consent or refusal of medical treatment is the reasonableness of the decision to uphold individual autonomy over the value of sanctity of human life. Moreover, there is the question of the necessary guidelines or signs before it could be decided that that a person exercised all necessary and rational steps before he arrived at a decision that could prolong or curtail his life.

            A patient is a person who has the right to decide everything that has to do with his own life. However, together with this right comes the responsibility to act responsibly. Before a patient’s refusal of medical treatment, it must be ensured that he is competent to make such an important decision. It must be ensured that he is apprised of all the facts necessary for him to make an intelligent decision. Thus, the patient must be told about the “nature and purpose of the procedure.” When making the decision, the patient must not be influenced by external factors. Finally, it must be made clear that the decision would apply to future circumstances (Michalowski, 2005).

            An advanced refusal against medical treatment is especially problematic in situations where the medical treatment is made necessary at a time that the patient is no longer competent to make decision. In such situations, the physician can no longer assess the competence of the patient at the time that the advanced directive was made. Thus, it is difficult to determine the validity and applicability of such advanced directive. The ambiguity extends to the meaning attached by the patient to the advanced directive at the time that he executed it. There is no means of ascertaining the specific extent  of the advanced directive (Michalowski, 2005).

            The determination of the validity and applicability of advanced directives is very critical because of the far-reaching consequences that would result if the issue is decided in either direction (Murphy, 2005). On the one hand, if the doctor errs in favor of preserving life, he runs the risk of being accused and prosecuted for battery, since the administration of unwanted medical treatment would constitute a violation of a patient’s autonomy and integrity as a person. Moreover, such decision might condemn the patient to an undignified or unbearable life that he does not want in the first place (Michalowski, 2005).

            It is a policy to ensure that the medical care received by the patients be consistent with their preferences, if the principle of patient autonomy would be given full effect and meaning. Despite the emphasis on individual autonomy in decision-making regarding medical treatments, there are some who are concerned about the reasons behind any decision of a patient on this issue (Winzelberg, Hanson & Tulsky, 2005).

            Thus, it is recognized that the decision of a patient to refuse present or future medical treatment might be influenced by various factors such as his ethnic and racial backgrounds, age, financial capability, and cognitive abilities. These factors could reduce the competence of a patient in deciding on the matter of whether medical treatment should be continued or not (Winzelberg, Hanson & Tulsky, 2005).

            Therefore, there is a need to improve the system of decision-making for patients to ensure that there is no duress or other external factors influencing his decision, thereby ensuring that individual autonomy is respected. One suggestion is to adopt strategies in decision-making to ensure patient autonomy. Another suggestion is to improve the communication system between the patient and the doctor in this stage of treatment so that the family would get assistance in getting sufficient information about the illness of the patient. Such information is necessary before the patient could arrive at an intelligent decision regarding his life (Winzelberg, Hanson & Tulsky, 2005).

            One issue about patient’s right to refuse treatment involves the power and the right of child patients to either consent or refuse treatment. In the same way that the competence of incompetent adults to decide at the time that they executed their advanced directives could not be easily determined, the consent to treatment of children below 16 years is not easily ascertainable (Parekh, 2006).

            Similarly with adults, there is a need to determine whether the consent or refusal of a child towards medical treatment was given by a competent person who could intelligently make a decision. However, in the present state of the law, children are not totally considered fully autonomous, such that they are only allowed to give their consent to treatment but not to refuse it (Parekh, 2006).

            In the case of children, there is no presumption of competence. Children are not believed to have the necessary faculties to understand all the implications of their decisions. Thus, the best interest of the child is often used to justify their lack of participation in the decision-making process when deciding end-of-life decisions (Parekh, 2006).

            While it is true that there is cause for concern with regard to children and their decision-making capacity, certain actions could be done to ensure that children are fully informed of the situation and the consequences of their options. For example, children could be informed of the medical, ethical and social perspectives relevant to the situation at hand. Thereafter, their autonomy should be respected and their will should not be replaced by that of their parents or guardians. Being the owners of their own lives and bodies, children are no less human beings whose autonomy should be respected in the same way as adults (Parekh, 2006).

            Therefore, while parental consent may be important in any decision arrived at by minor children, parents’ opinion should only be directory and not mandatory. Children, particularly those with terminal illnesses, should be accorded the right to decide whether they should push through with the difficult and painful treatment process or succumb to their illness without resorting to life-saving medical treatments (Derish & Heuvel, 2000).

References

Alberts, W. M. (2007). Follow up and surveillance of the patient with lung cancer: What          do you do after surgery? Respirology 12, 16-21

Derish, M. T. & Heuvel, K. V. (2000). Mature Minors Should Have the right to Refuse   Life-Sustaining Medical Treatment. Journal of Law, Medicine & Ethics 28, 109-       124.

Michalowski, S. (2005). Advance Refusals of Life-Sustaining Medical Treatment: The             Relativity of an Absolute Right. The Modern Law Review Limited 68(6), 958-982.

Murphy, P. (2005). Are Patients’ Decisions to Refuse Treatment Binding on Health Care             Professionals? Bioethics 19(3), 189-201.

Parekh, S. A. (2006). Child consent and the law: an insight and discussion into the law         relating to consent and competence. Blackwell Publishing Ltd., Child: care, health and development 33(1), 78-82.

Stuhmiller, D. F. E., Cudnik, M. T., Sundhelm, S. M., Threlkeld, M. S. & Collins, Jr., T. E.          (2005). Adequacy of Online Medical Command Communication and Emergency           Medical Services Documentation of Informed Refusals. Acad Emerg Med 12(10),     970-977.

Winzelberg, G. S., Hanson, L. C. & Tulsky, J. A. (2005). Beyond Autonomy: Diversifying         End-of-Life Decision-Making Approaches to Serve Patients and Families. Journal     of the American Geriatrics Society 53, 1046-1050.