When Patients Refuse Treatment

Mrs. Jones is an 85-year-old woman whose life depends on dialysis treatments three times a week. Hospitalization and treatment for her multiple medical problems have caused her to become disoriented and agitated at times; she cries out and protests when nurses try to care for her. Her physicians recently told her daughter that, in addition to diabetes, end-stage renal disease, and a poorly-healed hip fracture, the patient is developing congestive heart failure. During each treatment, when she must lie still in a painful position, she insists that she does not want to be treated. Medication must often be administered to prevent agitation during the five hours that each treatment requires. At times she must be gently restrained to prevent the dialysis lines from being pulled out.

Meanwhile, elsewhere in the same dialysis unit, Mr. Smith is being prepared for treatment after coming to the Emergency Department severely uremic, having missed over a week of dialysis treatment because he is “too busy.” He smells of alcohol, although his blood alcohol is slightly below the legal limits for driving. Mr. Smith refuses to cooperate, insisting that he will not undergo treatment, and while in the dialysis unit, attempts to hit one of the nurses....

Also: HPV mandatory and Conscientious objection.

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Bioethics in Brief is a newsletter of the Center for Bioethics and Humanities, committed to promoting clinical health care and health policy which is patient-centered, compassionate, and just. Opinions expressed in the newsletter are those of the authors and do not represent the position of the Center.

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