Refusal of Medical Treatment
That patients exercise 'rights' to autonomy when providing consent only
makes sense if there is a corresponding right to refuse, and so this
module considers the nature and scope of the right to refuse or withdraw
consent to medical treatment. Further, it explores whether the right is
subject to limitations, and specific criteria that apply. Mirroring the
module on positive consent, a thorough understanding of refusal
encompasses many of the same 'categories' of patient encountered in the
previous session.
A key question to consider during this module is whether consent and
refusal are two sides of the same coin? If so, does it mean that the
criteria and principles applied to the former must be applied with equal
weight and effect to the latter? In logic, there is no difference in the
'ability' to either consent or refuse. In law, however, we find that the
two aspects are often treated distinctly, with higher thresholds being
required by the courts in relation to refusals.
Aims & objectives
Understand how the presumption of capacity operates in the context of
refusals, and what thresholds must be satisfied before treatment can
lawfully proceed;
Consider the problems that arise when there are disputes over the nature
or substance of a refusal, and the potential for uncertainty in both law
and practise in determining whether to override a patient's expressed
wishes - particularly when the dispute involves parental refusals;
Survey the different approaches and rules that attach to different
'categories' of minor, and how the concept of concurrent consent
manifests itself in refusal situations; and
Look at categories of 'vulnerable' patient, including those with
conditions like anorexia, those who are incarcerated, and those in
late-term pregnancies.
Learning outcomes
By the end of this module, you will be able to:
Appreciate when, and how rarely, the courts override patient refusals;
Comment on the dilemmas of consistency and principle which arise in the
context of minors' refusals, the relationship to parental wishes, and
the power of the courts;
Discuss the question of whether there are, or should be, differences in
approach to refusal of treatment decisions than 'positive' consent,
especially in the context of various 'incompetent' patients (including
minors); and
Compare and contrast the approaches to refusal of treatment by women in
late-term pregnancies, both in terms of their capacity, interests and
rights, and the effect those have (or do not have) on the 'potential
life' they are carrying.
Examples of the questions explored in this module
What is the standard of care in relation to the nature and volume of
information that a patient should 'reasonably expect' to receive
regarding proposed treatment?
When, and to what extent can minors consent to treatment?
Take-away Toolkit
Core principles for approaching consent and refusal of treatment
specific to the "special cases" of minors, the mentally incompetent, and
other "vulnerable" patients.
