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Refusal of Treatment
· Refusing Consent:
o Adults may refuse medical treatment even if it results in the person‟s injury or death
o A pregnant woman may refuse treatment even if that jeopardises the life of her unborn baby
o Not clear whether a competent child (under 20) can refuse treatment
o Parents may refuse on behalf of children, except where refusal endangers the life of the child.
o Parent‟s right to practice religion etc does not extend to placing their child‟s health at risk
· Issues to consider:
o Competence: are they „autonomous‟. Normal presumption is that they are, unless clear evidence to the contrary. Is the condition affecting their judgment? You can only have „justified paternalism‟ where the person is autonomous. You are not being paternalistic where patient in incompetent.
o The higher the level of risk, the greater need for evidence of competence (not just competence per se, but evidence of competence)
o Informed consent: requires a competent person to voluntarily make a decision, who understands all the relevant information, including the doctor‟s recommendation.
o Prognosis: if advanced terminal illness then this is different to where recovery is likely
o Is the patient absent from coercion
o Irreversibility of a decision not to intervene vs. reversibility of decision to intervene. Given this asymmetry, strong bias to intervention.
o Weighing families wishes against patients
o Loss of liberty and prolongation of misery if you intervene
· When is paternalism justified:
o If intervention will probably prevent significant harm
o Where benefits outweigh risks
o Where the least autonomy restricting option that ensures the benefit is adopted
· Refusal of treatment on grounds of religious belief:
o They still want treatment
o Danger in accepting refusal to accept treatment at face value
o Ensure understanding („Why do you think this? Do you realise you are going to die without it?‟)
o Ensure authenticity of beliefs (do they say they JW to avoid blood products they think are contaminated)
o Identify acceptable treatment options
· Consequences of treating without consent:
o Breach of the patient‟s rights under the Bill of Rights/Code
o Disciplinary action
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