Question

Mrs. J will not allow the staff to touch her, turn her, or care for her wound. She tells everyone to leave her alone and will not take medication for her infection. She angrily yells at her family and refuses to let them visit or help with her care. Everyone is concerned about her declining health and unwillingness to participate or allow care. Provide recommendations for management of the ethical dilemma inclusive of the possible choices and resulting consequences as well as who to engage in the decision making. Summarize the issues and recommendations in your final paragraph

Answer 1

In such a situation. try to look at the situation from patient’s perspective to know the  reason why he is not treatment noncompliant. Try to speak to that reason with compassion and concrete reasons why he should work with his doctor to rectify that problem rather than try to handle it on his  own.

Competent patients have a right to refuse treatment. This concept is supported not only by the ethical principle of autonomy but also by U.S. statutes, regulations and case law. Competent adults can refuse care even if the care would likely save or prolong the patient’s life.

recommendations:

• Educate the patient as fully as possible about the benefits of treatment recommendations and the risks of no treatment.
• As much as possible, discover the patient’s reasons for refusing care and discuss these with the patient to see if there are ways to negotiate so that the patient can receive care that is in his or her best interests.
• With the patient’s permission, speak with family, clergy or another mediator if you think this might help the patient reconsider his or her refusal.
• Consider a mental health referral if the patient has overwhelming anxieties about receiving care or shows psychiatric comorbidities and is willing to be evaluated.3
• Consider using “hope and worry” statements to aid in discussion of refusals: “I hope that you don’t have a serious disease, but I worry that your symptoms may indicate serious disease is already present.”4
• Document your efforts to educate the patient, the rationale for your recommended treatment, and the patient’s refusal of care.
• Ask the patient to sign a refusal of care form.

issue can be worsening of patient condition in the form that wound can be infected which ultimately will cause septicemia.