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What You Need To Know To Deal With Treatment Refusal | Consent - YouTube
Channel: Dr Erwin Kwun
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have you ever found yourself in a
situation where your patient refused the
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treatment recommended this ethical
dilemma is common in clinical practice a
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competent adult has a right to consent
or reject treatment the reason for
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treatment refusal does not have to be
sound
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or rational in fact a patient does not
have to give any reasons at all the
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doctor is bound to respect the refusal
to treatment of a competent adult
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exceptions to the ethical principle of
respect for autonomy do exist under the
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Mental Health Act 1983 patients with
psychiatric disorders may be lawfully
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detained in hospital against their
wishes for treatment hi everyone this is
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Dr. Erwin Kwun my mission is to help
doctors lead a happy and fulfilling life
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I publish new video every Thursday on
the subject of happiness and success if
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you have not already subscribed this
channel don't forget to subscribe and
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ring the bell so you are notified first
each time I release a new video in this
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video we will cover what you the doctor
do if patient refuses treatment first
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thing first I'd like it to pose this
video and write in the comment section
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how do you approach a patient who
refuses treatment I am to read and
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respond to every comment please write
down how you would approach the scenario
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before watching the rest of this video
it is crucial to consider three key
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points the first point being capacity
capacity is the ability to make a
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decision
or take an action that impacts on a
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person's life the capacity of a patient
to make decision about their own care
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and treatment is fundamental to the
ethical principle of respect for
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autonomy capacity should be assumed
unless proved otherwise
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if a patient declines treatment it's
important to assess the person's
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capacity the mental capacity Act states
that someone is unable to make a
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decision if they cannot meet one or more
of the four criteria the first quarter
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being understand the information
relevant to the decision this includes
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reasonably foreseeable consequences of
whatever decision is made
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were failing to make a decision the
second criteria is retained that
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information in making
decision the third criteria is user way
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the information available the loss
criteria being to communicate the
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decision by any means including speech
sign language or simple muscle movement
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a person failing one or more aspects of
this task is deemed to lack the relevant
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capacity but you must try to find ways
of communicating with a patient before
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determining the lack capacity in other
words you must first assume capacity and
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support patient to make their own
decisions
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before deciding they do not have
capacity capacity is a key component of
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informed consent to medical treatment a
competent adult is entitled to decline
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treatment even if the doctor disagrees
with their decision or believe it to be
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unwise the second point is informed
decision the doctor has a duty to give
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appropriate information about what
treatment involves the benefits and
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risks of treatment must be explained
consequences of not going ahead with
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treatment must also be discussed the
doctor must discuss reasonable
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alternative treatments in other words
the patient needs to be sufficiently
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informed to be able to make a choice let
me give you a working example mr. Smith
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aged 67 suffers with crushing chest pain
you're worried he might have an acute
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coronary syndrome and recommends
admission to hospital for further
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assessment and treatment the patient
doesn't want to go to hospital in this
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scenario it is important to ensure that
mr. Smith is given sufficient
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information to make an informed choice
about admission the doctor must explain
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the consequences of not going to
hospital and delay in receiving
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treatment a major complication of acute
coronary syndrome is death this
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information needs to be conveyed
sensitively to the patient this could be
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phrased as following mr. Smith were
dealing with a potentially
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life-threatening condition
I would highly recommend we admit you to
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hospital for further assessment and
treatment now the patient is aware of
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death as a consequence he might choose
to accept the idea of admission if the
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patient has capacity and still makes an
informed choice to
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user recommended treatment the doctor
might want to explore the reason behind
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refusal treatment refusal could be due
to misinformation fear personal values
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and belief this might reveal a solution
or a different approach sometimes
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involving family members in the
conversation might help to get everyone
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on the same page the third board is
voluntary decision decision to consent
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or declined treatment must be made
voluntarily without undue pressure by
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health care professionals friends or
family in other words if a decision is
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made under coercion it is not valid it
is worth highlighting the difference
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between persuasion and coercion
persuasion is the act of changing a
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person's attitude or behavior by
rezoning coercion is a use of fear or
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threat to compel a person to make
decision involuntarily persuasion can be
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used as long as a patient is not being
coerced to make a decision it is worth
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knowing about advanced lesson a
competent adult can make a decision to
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refuse particular medical treatments for
a time in the future when he may not be
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able to make such a decision this is
known as a living will this includes
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refusal to treatment that could
potentially save the person's life such
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as ventilation and called a pulmonary
resuscitation CPR advanced decision
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needs to be discussed with a health care
professional patient can change their
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mind and review their decision if a
patient refuses treatment and then
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decides that they want to go for
treatment they need to be aware that
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they can do so it is essential to
consider the three points we have
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covered when dealing with treatment
refusal capacity informed decision and
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voluntary decision if you want more
videos like this smash the like button
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if you have not already subscribed don't
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time I publish more videos thank you so
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much for watching take care everybody
see you in the next video
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