Refusing Medical Treatment
Can a rational person refuse treatment?
Until recently, it was thought that there was something wrong with people refusing medical treatment. * It is believed that some irrational fear, misjudgment, or suicidal tendencies prevent the patient from reaching the conclusion that treatment is the only viable option. .
It is only now that the medical profession has become more open to the idea that refusing conventional medical care may be a reasonable and informed choice made by someone in full responsibility for its faculty.
For example, although in the 1970s this concept was discussed in the patient rights bill model and implied in the consent principle, in 1990 the American Association of Physicians & Surgeons adopted a list of freedoms that must be guaranteed to all patients which included the freedom to refuse treatment. medical even if it was recommended by their doctor.
Understandably, doctors find it difficult to accept when their treatment paradigm is challenged. Often, they are very disturbed by the patient’s decisions and will continue to try to get them to change their minds; others will care to cover themselves if the patient or family later decides to demand inadequate care.
Refuseniks is not a small fringe group
Treatment refusals (sometimes referred to as “refusenics”) are often early in their illness, and the interventions they refuse are considered “active” because they are intended to cure or control the disease, not “palliative” i.e., intended only to comfort the patient. patient.
While Christian Scientists who rely on prayer or Jehovah’s Witnesses who refuse blood transfusions make headlines, most people who refuse treatment do not do so for religious reasons or because of a deep distrust of modern medicine. In fact, many patients will accept part of a doctor’s recommendation – surgery to remove a tumor, for example – only to refuse further therapy such as chemotherapy or radiation.
These patients perform some kind of cost/benefit analysis. For example, in the case of chemotherapy drugs, they mention that unlike most drugs, which provide a high probability of benefit with possible harm, many anticancer drugs, provide almost certainty about harm with only probable benefit.
Therapy can prolong life — but for how long? And how much does it cost? There are no studies yet — because withholding treatment from a control group would be unethical — but one survey comparing nearly 800 patients who refused all conventional cancer treatment with those who received treatment found that refusal shortened the median length of survival by nine months.
The survey was extensive: subjects had 30 types of cancer at various stages of the disease, and survival ranged from two months to more than six years. But the bottom line is that sometimes treatment gives you a lot of time, and sometimes it doesn’t.
Older patients are more likely to refuse treatment
Therefore, and supported by statistics, older patients refuse treatment more often than younger patients. Often, they feel that they have lived their lives, or that the opportunity to live a little longer does not justify the consequences involved in undergoing treatment. In one survey of women with breast cancer, 7% of women 65 or older refused treatment, compared with 3% of women under 65.
Older men with prostate cancer often delay surgery out of concern for side effects such as incontinence and impotence, and at the fact waiting and monitoring such PSA levels is sometimes a doctor-approved option. Usually, however, patients are not given enough information or time to negotiate, a complaint frequently cited by proponents of complementary and alternative medicine.
A value assessment
In general, rejectniks are intelligent, articulate, and fully aware of the possible consequences of their decisions. They don’t use medical evidence as the sole — or even the main — factor in their decision making, although they do report gathering a lot of research on proposed treatments. Instead, they make choices based on their values, such as the belief that the meaning of life is greatly diminished when the ability to live it normally is compromised.
They don’t want to live as long as possible if it means losing bodily integrity and personal independence. Sometimes they rely on the personal experiences of friends who have received similar treatment. They believe in the goodness of the doctor’s intentions and often also in the skill of the doctor, but in the end, they choose the route that they think will give them a better sense of control, quality of life, and dignity.
More options needed
With this new view of rejectniks, the challenge for the medical profession is to provide wider options, better options, and alternative medicine for those who choose to avoid conventional medical treatment.
* An important exception is where such treatment is prohibited by religious or moral beliefs. This article focuses on the right of competent adults to make decisions about their own care — not if the decision maker lacks the capacity or if the decision is for someone else, including minors.
Disclaimer: Nothing in this entry should be construed as medical advice, and no action or refrain from action should be based on it. Anyone who needs to address the issue presented in the entry is advised to consult their health care professional immediately.