The patient is the ultimate decision maker concerning his/her medical care. It is the patient who gives the final word on whether to undergo a recommended medical procedure or treatment. The purpose of the physician in patient care is just to determine the best treatment for the patient’s problem based on their medical knowledge and judgment and present the recommendation to the patient to seek for their consent (Parker, 2013). The physician is to provide the patient with the necessary information on their condition and the treatment recommended, its benefits, possible risks, the complications in the procedure and if there is any alternative for the procedure. This is complying with the informed consent doctrine and the patient decides if they want to undergo the procedure or not.
The four main ethical principles in medical ethics encompass autonomy, beneficence, non-maleficence and justice. These principles are applied by healthcare providers in many ethical dilemmas in health care. One of the medical dilemmas that these principles’ can be applied to is patient refusal of care.
When a patient refuses care they should be informed of the consequences. The principle of autonomy comes in due to informed consent; a patient has a right to accept or refuse treatment. Informed consent is when a medical practitioner discusses with a patient prior to a nursing care procedure in order to protect patients autonomy. Before any procedure is performed on a patient, consent should be obtained from him or her appropriately so as to avoid refusal of treatment by the patient. If there is no consent from the patient and he/she refuses treatment, it cannot be administered and this infringes the patient’s autonomy and contravenes the consent principle. A physician cannot force a patient to undergo a particular procedure or treatment since a patient has a right to refuse treatment (Aveyard, (2004). The principle of autonomy involves a patient’s privacy and confidentiality after consultation and agreement. The healthcare providers should respect a patient’s autonomy by communicating well with them and giving them adequate information about the procedures they are to undergo.
The principle of beneficence is applied when a patient refuses care in order to help improve their situation and to benefit them. Doctors do have an obligation to prevent and remove harm and to weigh the pros and cons of an action. Therefore through the principle of beneficence, when a patient refuses treatment, physicians will do all they can to help the patients and rescue them from danger. The principle of beneficence only allows physicians to act in the best interests of their patients. The healthcare provider is to do good for the wellbeing of the patient.
Non-maleficence stands for not to do any harm. It is a principle that guides physicians not to administer procedures and ineffective treatments that might cause harm to patients. The physician has to weigh the benefits and the burdens of the procedure first since many procedures have serious risks yet they are still followed and come out successful. The physician’s actions must be balanced by proportional benefit and the patient must decide whether it be administered or not by weighing the potential harms and benefits of the treatment. Therefore, a patient can refuse treatment after weighing the potential harms and benefits and decides that the medication is harmful or the procedure is ineffective. A physician has to consider beneficence and non-maleficence and come up with benefit with no harm to the patient who has refused treatment.
The principle of justice in medical ethics concerns fairness and equality on the distribution of health resources and treatment. Healthcare providers should be fair when offering treatment to their patients without prejudice. Moreover, they should be able to justify their actions in all situations for their patients. Every patient should be treated in a fair way and healthcare providers should avoid giving special treatment to certain patients than others.
At times the principles conflict each other and physicians are forced to choose what they prefer best (Pozgar, 2012). Autonomy sometimes conflicts beneficence whereby a patient conflicts with the recommendations from the physician and in this case, beneficence is considered over autonomy because it is better to act in the best interests of the patient by causing no harm and saving the situation. As much as patients have a right to control what happens to their bodies, it is important for the healthcare providers to act in the benefit of the patients by trying to improve their patients’ health.
A patient might refuse treatment because he/she has a right to do so but it is the duty of the healthcare provider to explain to them why the procedure is important and apply the principle of beneficence if the patient turns out to be difficult. The four principles in medical ethics offer a simple and neutral approach in ethical issues in healthcare including patient refusal of care. The approach is based on autonomy, beneficence, non-maleficence and justice. These four principles help health care providers in making decisions about patients who have refused treatment. At times they conflict with each other but it is the duty of the physician to choose between them.
Parker, M. (2013). Ethics and Community in the Health Care Professionals. New York: Routledge Publications.
Pozgar, G., D. (2012). Legal and Ethical Issues for Health Professionals. Wadsworth: Jones & Bartlett Publishers.
Aveyard, H. (2004). The patient who refuses nursing care. Journal of Medical Ethics, 30(4), 346–350.