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Results for “Treatment Refusal”

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PubMed1984

Limits of guardian treatment refusal: a reasonableness standard.

The debate concerning the legal and ethical bases of guardian refusal of medical treatment on behalf of incompetent patients often ignores critical distinctions among types of patients and guardians. For example, patients who have expressed preferences regarding treatment while competent are distinguishable from patients who have always lacked the competency requisite to expressing a treatment preference. "Bonded guardians," whose relationship with the patient preexisted guardianship, should have a different role in the decision-making process than "non-bonded guardians," who were strangers to the patient prior to the guardian-ward relationship. This Article proposes criteria for guardian treatment refusal on behalf of incompetent patients. Under the model for guardian decision making presented here, bonded guardians should be preferred over non-bonded guardians, and bonded guardians should be allowed discretion to make treatment choices, limited only by a standard of reasonableness policed by the courts. The Author presents legal and ethical justifications for the bonded guardian's heightened role. Finally, he considers the proper roles of health professionals, hospital ethics committees, and judges in the decision-making process.

Decision Making↗
PubMed1988

The influence of the right to refuse treatment on precommitment patients.

The unplanned extension of the right to refuse treatment to the precommitment period is described in this paper. This extension of the right to refuse treatment has important public policy implications for the civil commitment process. These implications, as well as the pros and cons of the extension of the right to refuse treatment, are discussed.

Adult↗
PubMed1985

[Right to refuse treatment by the involuntary patient: medico-legal considerations].

Forensic topics are discussed in relation to the right to refuse treatment among involuntary hospitalized patients. A clinical case is reported emphasizing the medical and legal dilemmas which the psychiatrist has to cope with. Different legal procedures are examined and their deficiencies discussed; the right to refuse treatment is discussed with reference to recent cases heard in the U.S., The Charter of Rights of the Canadian Constitution 1981 and the "Charte des droits de la personne du Québec". The recommended solution in cases of treatment refusal among involuntary patients centers on the judiciary determination of incompetency of such patients.

Canada↗
PubMed1981

The right to refuse treatment: why psychiatrists should and can make it work.

There is a right to refuse treatment and this right already exists in the legal doctrine of informed consent. The basic legal justification for overcoming this right is the incompetence of the patient. Incompetence is also the central consideration in overcoming any constitutional right to refuse treatment. The constitutional theories of the right to refuse treatment are briefly presented and their implementation in different recent decisions is considered. A distinction is made between the requirement of proving incompetency and the requirement of appointing a neutral party as arbiter for incompetent patients. A recent constitutional ruling that recognizes this distinction and permits psychiatrists rather than neutral arbiters to make treatment decisions for patients is discussed as a model that should be acceptable to psychiatry.

Forensic Psychiatry↗
PubMed1993

Predictors of dental students' belief in the right to refuse treatment to HIV-positive patients.

We examined predictors of dental student's belief that they should be allowed to refuse treatment to HIV-infected persons. We surveyed 181 first; second-, and fourth-year dental students at a large urban university using a 44-item, self-administered anonymous questionnaire and a measure of dispositional optimism. Several composite measures were created and their relationship to belief in the right to refuse treatment was assessed. Regression techniques were used to describe the relationship between the dependent and independent variables. Results indicated that non-professional attitudes, low optimism scores, low levels of comfort with homosexuality, and gender were the best predictors of belief in the right to refuse treatment to HIV-infected patients. Neither knowledge of HIV, year in dental school, or fear of contagion reliably predicted belief in the right to refuse treatment.

Adult↗
PubMed1997

Treatment refusal procedures and service utilization: a comparison of involuntarily hospitalized populations.

This article examines treatment refusal in a large group of hospitalized civilly committed patients. Comparison is made between those subjects whose refusal was reviewed by Oregon's administrative procedures for treatment refusal (override group) and those committed patients who more readily accepted treatment and were not evaluated by this procedure. The objective was to examine the override process and to explore potential differences between these groups in their utilization of hospital and community mental health services before and after the index hospitalization. We reviewed hospital charts on all subjects who went through the administrative override procedure and collected state hospital and community mental health services information from the statewide computerized information system on all subjects in the study. Several key differences were found between the groups. The override sample had significantly more women, and these patients spent significantly more time in the index hospitalization and had had more past hospitalizations. There were no differences between the groups in their utilization of community services before or after the index hospitalization and no difference in hospitalization rates after the index hospitalization. The conclusion is that the Oregon override procedure is functioning consistently, without undue delay in decision making. More investigation is necessary to determine whether override subjects represent a distinct subpopulation within the larger group of chronically mentally ill patients.

Adult↗
PubMed1981

The right to refuse treatment: ethical issues.

To understand the emerging concept of the right to refuse treatment in mental institutions, several underlying ethical issues must be examined. For example, the right is limited by such factors as the competence of the patient, the distinction between apparent and real refusal of treatment, and the desirability of some balance between the state's police power and parens patriae power. The most difficult ethical problems arise when a mentally ill individual is competent and not dangerous, needs treatment, and yet refuses it. In addition, most problems concerning the right to refuse treatment occur in large, understaffed, and underfunded public institutions whose nature affects the alternative treatments available, the quality of life without treatment, and the subtle coercive elements associated with any total institution. The author discusses these and other ethical issues pertaining to justifications for the right, limits to the right, treatment setting, and the treatments themselves.

Ethics, Medical↗