Term Paper on "Ethics Is a Patients Irrational Decision to Refuse Treatment Binding to a Health Care Professional"

Term Paper 5 pages (1900 words) Sources: 2 Style: APA

[EXCERPT] . . . .

Philosophy

However, if the patient is irrational or uninformed, it could have profound implications for the health care professionals treating the patient, and they could end up in court if they do not have the proper documentation of consent.

Argument a.

The patient has the right to fee will with their own mind and body.

Religious reasons may be a larger deciding factor to refuse.

One's cultural norm is not the same as another's and there for treatment cannot be forced.

Irrational patients, their guardians, and treatment.

Specific case examples.

Counterargument - Examples of invalid arguments.

Response.

Examples to prove the argument valid.

Patient Decisions Not to Treat

The purpose of this paper is to introduce and analyze the topic of patient decisions on the health care professional. Specifically it will discuss whether a patient's irrational decision to refuse treatment is binding to a health care professional. A patient's consent to treatment has become a thorny issue in the courts and in the nation's health care facilities. A patient has the right to refuse medical treatment for moral, religious, or cultural reasons. However, if the patient is irrational or uninformed, it could have profound implications for the health care professionals treating the patient, and they could end up in court if they do not have the proper documentation of consent.

Patient's rights are a critical concern in the health care profession today, and few will argue that a competent patient has the right to free will and to choose what happens to their own body. Some patients with religious convictions may choose to refuse certain treatments, such as abortion, and some patients from other cultures may refuse certain types of treatment that do not agree with their cultural beliefs. However, anyone who consciously desires treatment should be treated by the health care professional. For example, a difficult patient sometimes refuses treatment or hygiene care irrationally, but at other times allows and even demands that treatment. One article notes this problem with a disabled nursing home patient who alternately demanded and then refused specific treatments. The author notes, "Many feel that the only way to pay proper respect to autonomy is to let patients decide themselves what is good for them. From this point-of-view, Mr. A has the right to give significant input regarding what care he receives and how it is provided (Silvers, 2007). Indeed, if the patient is competent, the health care professional is bound to provide (or not provide) the treatment the patient demands. However, if the patient is irrational, the health care professional must weigh the options and decide what is best for the patient medically, or what treatment their condition warrants. In fact, in some cases, the irrational patient's treatment may prolong life that is not viable or desirable, and in that case, treatment would not be given to a terminal patient. However, in most cases, irrational patients who refuse treatment have conditions that can be successfully treated to extend life or cure the ailment. In these cases, the health care professional is bound to treat the patient, because of the ethics of the health care community to save lives whenever possible, and because of the question of rational thought in the patient. This is especially true if the patient has designated a third party to act as a consenter, or in the case of an adult guardian.

This is especially important in the cases of irrational patients who do not approve to treatments or in the cases of guardians or parents who act irrationally when it comes to health care decisions. Two health care legal experts write, "The health care provider must be alert to situations where the patient is no longer able legally to give consent. If the patient has not provided a legally effective mechanism to shift the right to consent to another person, the health care providers must get a court order to continue treatment" (Richards and Rathbun, 2007). If the patient is irrational or incompetent, then a designated family member or other guardian or third party has been designated as the consenter, then the physician is bound to treat the patient according to the designated member's wishes, even if they are contrary to patient wishes.

However, if the patient is a minor, there are other complications. Consider the case of a seven-year-old Ohio boy with acute lymphoblastic leukemia (ALL). His physician prescribed chemotherapy with a favorable outcome of at least 85% for long-term survival. His parents initially consented to this treatment, but after three months, they became concerned and refused to allow any more treatments, instead choosing a holistic form of treatment. Doctors warned them the leukemia would probably return under this treatment, and that the cure rate would be less successful with chemotherapy after that. The parents went ahead with the holistic treatment, and indeed, the leukemia did return. The oncologist took the case to the family court system, where the courts refused to rule against the parents, citing that the child was still under the care of a supervising and approved physician. After the court case closed, the child did have a relapse into acute leukemia. This indicates the dilemma facing many health care professionals. The doctor knew providing chemotherapy treatment was the right thing to do for this child, but was bound by the courts to discontinue treatment due to patient and parental rights. Thus, the doctor was bound to provide treatment until the courts ruled against it, and this is true for other cases and conditions, as well (Hord, et al., 2006).

There is another issue facing the health care professional in these situations. If an irrational patient refuses treatment, the doctor withholds treatment, and the patient dies, the hospital or health care facility could be sued for malpractice, even if the patient refused treatment. Legal authors note, "From a quality control point-of-view, the health care provider must always weigh the chance of harming a patient against the potential liability for deviating from the letter of the law" (Richards and Rathbun, 2007). Thus, the health care professional may end up being libel if the patient dies and he or she withheld treatment, even if the patient refused treatment. If the patient's family or friends know the patient was irrational, and question the health care professional's judgment, there could be many legal complications from that decision, which is another reason that the health care professional is bound to care for an irrational patient who refuses care.

However, many people believe that patient rights are the highest form of rights in health care, and they can never be overruled by the health care professional. Even if the patient is irrational, they have the right to decide what is going to happen to them and what they want done to their body. This analysis is flawed for several reasons. First, the patient, if irrational, may be incapable of fully understanding the implications of treatment and long-term survival. The health care professional is bound to make sure the patient understands all nuances of the procedures and treatments, but they are not bound to take the patient's denial of treatment seriously if the patient is incapable of rational thought. In fact, the health care professional could be found liable if they do not give treatment to an irrational patient who has refused treatment, simply because the patient may not be capable of making rational decisions, and other family members may protest if the patient is not treated. Thus, the physician is bound to treat the patient in the best way possible if the patient is irrational and there is no other rational person to make that choice. Patient rights are certainly important, even vital in the health care industry, but patient rights revolve on the assumption that the patient is rational and informed. In the case of an irrational patient, they are informed, but they are unable to make a rational decision about their treatment, and so, the health care professional must step in, rather than simply fall back on patient's rights and the need to preserve them.

This is a valid and very real argument for a number of reasons. An abusive or irrational patient "cannot be held responsible for his actions; nor can he be expected to perform the duties that would be required of him were he competent. His physicians need to make a sympathetic effort to understand the complex causes of [his] abnormal behavior and motivations" (Silvers, 2007). Thus, if there is no other person responsible for the patient, it falls on the physician to decide treatment, because the irrational patient is not competent or held accountable. Thus, the health care professional is bound to treat the patient, and bound to find the best treatment for the patient's condition. Two legal experts also note that very few incompetent patients ever sue a physician or facility for treatment they decided they were bound to give (Richards and Rathbun, 2007).

In addition, there may be health and safety concerns for… READ MORE

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