A patient's right to refuse treatment

By: wafa Abdullah ahmed hamood

ECG
Group: 1
Within the framework of clinical practice, two types of consent are recognized: implied and
informed consent.
While implied consent covers life-saving procedures in urgent situations, informed consent
safeguards patient autonomy and their right to make decisions affecting their bodies .In
prehospital and emergency care, conflicts can arise, with healthcare providers often unsure
whether a patient fully comprehends the implications of refusing medical care and when the
patient loses their decision-making capacity. When faced with a patient who refuses treatment,
healthcare providers have limited options that are largely contingent on the patient’s mental
competency. They can respect the patient’s decision, attempt to persuade the patient
otherwise, or provide treatment despite the patient’s refusal. However, the latter two options
either require exceptional communication skills or disregard patient autonomy.
Encountering patients who refuse ambulance services can precipitate ethical dilemmas for
healthcare professionals. Balancing respect for patient autonomy—the right of patients to make
their own medical care decisions, including refusal of treatment or hospital transfer—with the
necessity to provide appropriate medical care can prove challenging The reasons behind refusal
of medical attention or discharge against medical advice are manifold and complex, ranging
from misunderstandings and language barriers to denial of illness, mistrust of the healthcare
system, previous unpleasant experiences, fear, anger, and family obligations ]. It is vital for
healthcare providers to understand these factors to better address them and provide optimal
patient care.
According to Saudi Arabia´s bill of rights a patient has the right to refuse the treatment as
follow:
Refusal of Treatment:
• Informing them of the possibility of rejecting all or part of the prescribed treatment in a
manner that does not contradict with the applicable laws and regulations, and informing them
of the expected results of the refusal decision. The patient or their legal guardian shall be fully
responsible for their decisions and actions in the event of refusal of treatment or failure to
follow the treatment instructions, with the need to have them sign the acknowledgment form
for the prescribed procedure and then document this in the patient’s file.
• The refusal of treatment shall not result in any decisions or procedures that are not related to
the patient’s health condition, and the service provider in the health facility is obligated to
continue providing the appropriate care, even during appointments for the same disease or
others, in accordance with the medical standards followed.
• Informing them of other alternative treatments in case of refusal.
• Refraining from performing resuscitation to treat patients with illnesses in accordance with
legal fatwas and laws in the Kingdom of Saudi Arabia.
In Saudi Arabia the informed consent is a form of treatment Acceptance or refusal.
*Definition of Informed Consent:
Approval by the patient, his guardian, or his representative to the health facility or to the health
practitioners
Performing all necessary procedures to maintain and recover the patient’s health.
*Components of Informed Consent:
1. Consent (the patient, his guardian, or his representative).
2. Authorized for (the healthcare facility or the practitioner).
3. Authorized action (the procedures required to maintain and regain health).
4. The format (indicate approval and consent – in verbal or written form).
*Conditions of Informed Consent:
1. To be given by the authorized person.
2. The person who gives the Informed Consent must fulfil the legal capacity.
3. The consent procedure must be legitimate.
4. The consent shall be in a language to be understood by the patient, and shall be stated
verbally in a clear manner.
5. The consent is valid until the end of the specified medical procedure.
6. The approval must be voluntary to the consent not forced.
7. It must be given while the patient is fully aware and conscious.
*If the patient is a rational, sane adult, then the informed procedure is a
right of the patient, so no one can compel him to authorize, nor authorize
on his behalf.
*The medical team should not force the patient or his relatives to give
consent
*Penalties of healthcare providers:
According to Article (32) Law of practicing Healthcare Professions:
1-Warning.
2-A fine not exceeding ten thousand riyals.
3-health profession license practicing cancellation, strike him off the roll of license.
The cases:
*Cesareans:
1-In 2011 After two cesarean sections, Rinat Dray wanted to give birth naturally .But when she
arrived at Staten Island University Hospital in labor, the doctor immediately began pressuring
her, she said, to have a C-section. The doctor told her the baby would be in peril and her uterus
would rupture if she did not; he told her that she would be committing the equivalent of child
abuse and that her baby would be taken away from her. After several hours of trying to deliver
vaginally and arguing with the doctors, Mrs. Dray was wheeled to an operating room, where her
baby was delivered surgically. The hospital record leaves little question that the operation was
conducted against her will: “I have decided to override her refusal to have a C-section,” a
handwritten note signed by Dr. James J. Ducey, the director of maternal and fetal medicine,
says, adding that her doctor and the hospital’s lawyer had agreed.

2-On November 21, 2007, Ms. L, a 22-year-old woman who was in her ninth month of
pregnancy, was sent to Beijing Chaoyang Hospital by her cohabiter, Mr. X. The physicians
suggested an immediate caesarean operation because the patient had developed severe
pneumonia. However, Mr. X insisted for a normal delivery stating that Ms. L just had a cold. The
hospital learned that the pair was suffering economic hardships; consequently, they offered to
perform the operation free of charge. Ms. L went into a coma because her situation had
worsened, thus, her partner Mr. X was asked to sign the surgery consent form. Doctors had
spent three hours explaining the situation and persuading Mr. X, but he ultimately wrote “refuse
the caesarean section, and bear the consequences” on the form. Ms. L and the unborn child
both died despite continuous efforts to save them. On January 24, 2008, Ms. L’s parents filed a
civil lawsuit against the hospital. In December 2009, the Court of First Instance ruled that
Chaoyang Hospital had not caused any infringement, and the hospital decided to give the
plaintiff 100,000 yuan (around $14,500) on humanitarian ground

2-On August 27, 1994, a pregnant woman, Mrs. V, gave birth to a healthy baby at the Stamford
Hospital in Connecticut, US, but she endured heavy bleeding due to placenta residue. A blood
transfusion was proposed to save her life; however, Mrs. V and her husband refused the
procedure because it was against their religious beliefs. Before undergoing any procedure, she
executed a release requesting that no blood or its derivatives be administered to her during her
hospitalization, Mrs. V’s husband also signed the release. Despite the fact that Mrs. V would die
without blood transfusions, she and her husband maintained their decision. Her obstetrician, Dr.
C, tried dilation, curettage, and other alternatives that did not require blood transfusion, but her
condition continued to deteriorate. On August 28 at 2 a.m., Dr. C submitted a request to the
court regarding Mrs. V’s case, which resulted in the trial court eventually permitting the hospital
to administer blood transfusions. Mrs. V was then given blood transfusions and recovered from
the complication, but she appealed to the Appellate Court contesting the trial court’s judgment.
On April 9, 1996, the Supreme Court of Connecticut ruled that Stamford Hospital violated Mrs.
V’s right of self-determination.
References:
1-Case western reserve university: Birth Directives: A
Model to Address Forced and Coerced Cesarean by
Hannah Tuschm.
2-BMC Medical Ethics "Patient privacy and
autonomy: a comparative analysis of cases of ethical
dilemmas in China and the United States".
3-Saudi Guidelines for Informed Consent.
4-Laws of practicing of Law Healthcare Professions.
5-Basic Law of Governance of the kingdom of Saudi
Arabia.