MEDICAL ETHICS
A patient refusing treatment can present a difficult ethical dilemma. Medical adviser Dr Greg Dollman examines options and obligations in such cases
not to make assumptions about the same. Doctors should involve others (healthcare professionals and those close to the patient) when breaking bad news (as far as is appropriate), ensuring that information is relayed in a balanced way. GMC guidelines on Consent: patients and doctors making
decisions together and Treatment and care towards the end of life provide helpful guidance to doctors facing difficult conversations with patients. A patient should be involved in all decision- making, as far as they choose, with the doctor-patient partnership based on openness, trust and good communication. Doctors must consider the patient’s views of their condition, as
well as their needs and priorities, and should establish whether patients have understood the details they have been given and whether or not they require or wish more information prior to or aſter making a decision. Patients have the right to change their mind about a decision at any time, and doctors must keep them informed accordingly. Doctors making recommendations about treatment options
must be cautious not to sway inappropriately a patient’s decision making. Tey must take care not to express personal beliefs in a manner that may be seen to put pressure on the patient, cause distress or exploit their vulnerability. Te GMC reminds doctors to
act within the scope of their competence, seeking expert review from a colleague when appropriate. Patients have a right to seek a second opinion should they have concerns about their care, and practitioners should remind them of this. Te GMC requires doctors to be insightful and to reflect on the various situations they encounter in their everyday
practice. Doctors should discuss complex clinical matters with colleagues, who may be able to assist them through what is potentially a distressing period for all parties involved.
Conscientious objection Te GMC expects doctors to treat patients fairly and with respect, whatever their life choices and beliefs. Te GMC does recognise, however, that doctors hold their own beliefs and values. Its supplementary guidance, Personal beliefs and medical practice, states that doctors may practise medicine in keeping with their beliefs, provided that they act in accordance with the law and professional guidance. Should a doctor feel unable to be part of a clinical team where a
patient refuses potentially life-saving treatment, they must explain to the patient this conscientious objection, informing the patient of their right to see another doctor or actively seek a suitable practitioner to take over that patient’s care. Doctors must not imply or express disapproval of the patient’s choices or beliefs.
“I don’t want to talk about it, doctor” Patients who refuse treatment may choose not to communicate further about their decision, or may ask someone else to make decisions on their behalf. Doctors should follow the guidance as set out in Good Medical Practice, and discussed above, if faced with the former scenario. In the latter case, the GMC reminds doctors that while patients may ask family or close friends to play a significant role in decision-making, no one else can make a decision on behalf of a competent adult who has capacity. If, despite all attempts, a patient still does not want to know
about their condition or management, a doctor should respect their wishes as far as possible. Te GMC states that doctors are still obliged to engage with these patients as best they can, offering even basic information as the patient allows and reminding them of their right to change their mind at any time. So in summary, the law entrenches a patient’s right to say
“enough is enough” in any treatment, and professional guidance directs a doctor how to proceed in these invariably complex cases. But please do not hesitate to contact an adviser at MDDUS if you are uncertain how to proceed when a patient refuses medical treatment.
n Dr Greg Dollman is a medical adviser at MDDUS
AUTUMN 2016
13
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24