Running head: RESEARCH AND EVIDENCE: SUPPORT THE NEED FOR A CHANGE 1

Research and Evidence: Support the Need for a Change

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Research and Evidence: Support the Need for a Change

Article 1: Refusal of Treatment in a Young Patient with Recurrent Medulloblastoma

Patient autonomy is of great significance in the management of terminal illnesses and

conditions such as cancer. It is incumbent upon the practitioners including nurses and physicians

to understand that each individual patient have their attitudes, values, beliefs, and preferences

that influence treatment. The belief system of a society impacts on how its members perceive and

receive medical interventions. For instance, others might argue that prayers would be more

effective than treatment in cases such as the present one where the 29-year-old patient held that

autologous stem cell rescue and curative intent high-dose chemotherapy would not be as

effective as prayers as a means of intervention, something that contradicted the expert advice of

his oncologist. The bottom line, however, is that even in these cases, it is imperative to

underscore that the patient has the autonomy to refuse treatment even if their choices are

irrational from a medical point of view.

Patient autonomy is key to modern oncology. From the outset, it is essential to respect

patient autonomy as a principal tenet of contemporary oncology, including refusal of treatment.

However, it is the onus of the practitioner to persuade the patient to make a rational choice. Even

though it is difficult to conceptualize rational choice, the fact is that the physicians are at a better

place to tell what is medically best for their patients. As such, the practitioners should

communicate effectively with their clients so that they contextualize the reality of their

conditions and make better and informed choices. In this way, they can eventually be convinced

to reverse their earlier decisions of refusal and resume treatment for their healthy being and

wellness.
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The intervention of understanding the values and beliefs of the patients is important in

solving refusal because the practitioner can use it as the basis of highlighting to the clients what

is best for them. However, in some futile cases, it would be better to respect the autonomy of the

patients so that even their decision to refuse treatment is respected by the doctors and the nurses.

It also underlines trust and respect to the patient’s autonomy in the course of delivering optimal

care.

Article 2: Refusal of Potentially Lifesaving Dental Care: Antithetical Conflict of Ethical

Principles

Patients have gained more power to determine the course of their treatment in the last

couple of decades where the imposition of paternalism by doctors has dwindled. Today, doctors

seek the opinion of the patient and respect the accompanying autonomy. At some point, it can be

the expert opinion of the doctor that a given course of action would be beneficial to the patient,

yet the latter refuses to oblige. In such an instance, it is imperative that the physician seeks the

counsel of an ethicist to advice on the best remedy. Still, a doctor can opine that their patient is in

a fragile mental status, thus their refusal of medication or treatment. Under such circumstances,

family, relatives, and other significant others can be consulted to give a second opinion so that

what is in the best interest of the patient can take precedence. But, the imposition of paternalism

should not be a priority.

While intervening when a patient has refused treatment, it is crucial to reconcile three

important factors: the duty to promote a patient’s wellbeing; the responsibility of cushioning the

patients against danger; and the duty to respect the competent patient’s desires and inclinations.

The patient should then be afforded adequate information regarding the benefits of treatment vis-

à-vis the costs of refusal. Moreover, it is also prudent to establish the mental status of the patient
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so that it is known whether they are competent to give informed consent. If they are not mentally

sound, then it is advisable to rely on legally appointed guardians to influence the course of

action. When the patient is competent yet refuses treatment, then the determinants of the

irrational behavior like phobias should be investigated by clinicians followed by designing

creative measures to convey the right information.

This intervention is important in solving the problem of refusal in the sense that the

ethicist will advise and ensure that the doctors act ethically. Moreover, the legally appointed

guardians can intervene and make rational choices regarding informed consent because at some

point a patient may not be mentally sound to make the right decisions. Finally, establishing the

source of irrational behavior for the patients who are competent gives the practitioners the

opportunity to be creative in disseminating information in a way that does not trigger undesirable

patient responses so that they can continue with treatment.

Article 3: Evaluation of Decision-Making Capacity in Patients with Dementia: Challenges

and Recommendations from a Secondary analysis of Qualitative Interviews

Patients should have a say on their treatment for various diseases and conditions. But,

they should only do so when they have the decision-making capacity to give their consent or

refuse medication and treatment. In this way, it is essential that clinicians and physicians are

adequately trained so that they can effectively evaluate the decision-making capacity of their

respective clients. Not all patients who seek medical attention have the capacity to make the right

decisions consenting to medical treatment. For instance, it would not be rational to rely on a

patient with dementia to be competent enough to consent to medical intervention. As a result,

there is the urgent need for training for physicians concerning situation-independent obstacles to

decision-making capacity assessment.

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As a way of intervention, foremost it is essential to conduct decision-making capacity

evaluation for the patients so that informed consent or informed refusal can be understood. At

times there could be reasonable doubt concerning decision-making capacity, for instance in the

patients with dementia diagnosis. By focusing on informed consent, the doctor is able to ensure

that first all judicious steps have been accounted for to offer the requisite info for the clients to

make a decision. As an instance, the utility of giving the patient information comprehensively

and easily understandable way ought not to be underrated. The doctor ought to also consult with

the family so that refusal can be understood from the capacities of the patients. As well,

psychiatric consultations can also be important in establishing decision-making capacity.

Physicians do not live with the patients, making it important that they first understand the

patients as far as their ability to make informed decisions regarding consent or refusal is

concerned. This is why it is important to involve the family when there is reasonable doubt, like

in the cases of the patients who have been diagnosed with dementia. It is the responsibility of the

doctors to ensure the wellbeing of their patients. As such, they should act on the backdrop of the

understanding that their patients are competent to make informed decisions regarding refusal and

consent. If they lack the capacity, doctor can rely on their professional view and the family’s

input to determine the right course of action.

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References

Motloba, D. P. (2016). Refusal of potentially life-saving dental care: Antithetical conflict of

ethical principles. South African Dental Journal, 71(10), 467-469.

Poppe, C., Elger, B. S., Wangmo, T., & Trachsel, M. (2020). Evaluation of decision-making

capacity in patients with dementia: challenges and recommendations from a secondary

analysis of qualitative interviews. BMC Medical Ethics, 21(1), 1-8.

Tan, A. C., Kerridge, I. H., & Pavlakis, N. Refusal of treatment in a young patient with recurrent

medulloblastoma.