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Case Study

Refusing treatment

Dr P, a general practitioner had been treating a 63 year old man for a range of bowel symptoms. Colon cancer was detected and the usual range of treatments were proposed.

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The patient refused this potentially lifesaving treatment.  Dr P contacted MIPS for advice on how best to manage the situation. MIPS provided the following advice:

  1. Ensure the patient is aware that refusing treatment offered could result in a worsening of their condition or even death.
  2. You may need to be blunt in your recommendation, but remain respectful and professional.
  3. In a further consultation enlist the presence of the spouse/partner or family member so that the decision making process can continue at home. This way others are aware of what is being recommended and the patient’s natural denial mechanisms are kept in check.
  4. Allow time for decision making. Whilst advising the full details of the suggested treatment, organise another consultation shortly thereafter to discuss the decision, this will allow time for the decision making process to begin. Time to consider with loved ones often leads to a more considered and rational decision.
  5. If there is still refusal of the treatment or referral recommended, detail the patient’s decision clearly in your notes, including the names of others who may have participated in the process.  Note – no competent adult patient can be forced to undertake treatment against their will.

 

Resources

The Medical and Dental Board Codes of Conduct at 3.12 End of Life care:

3.12.5 Accepting that patients have the right to refuse medical treatment or to request the withdrawal of treatment already started.

 

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