Patients create ethical dilemmas for doctors all the time, but perhaps none so much as the patient who refuses lifesaving treatments.
That’s a problem for neurologist Andrew N. Wilner, M.D., who has had patients in his practice refuse medical treatment to the detriment of their health—and at great cost to the healthcare system, according to Medscape (sub. req.).
One example: One younger patient originally from Africa refused to take antiretroviral therapy because he didn't want his family to know he has AIDS. He does take medications to treat multiple complications. But his refusal to take antiretroviral therapy has led to frequent hospitalizations and an enormous bill that he can't pay.
Wilner wonders if the hospital is ethically required to treat the man’s complications when he refuses to treat the underlying condition.
The first question to consider, Ronald W. Pies, M.D., a bioethicist and professor of psychiatry at SUNY Upstate Medical University in Syracuse, said in the article, is the patient’s ability to give informed consent. In this case, the patient's central nervous system toxoplasmosis could have affected his ability to make rational decisions. A psychiatric evaluation would help determine mental competency and the ability to give informed consent, he said.
If the patient is judged mentally competent to make medical decisions, doctors must respect his decision to decline antiretroviral therapy, Pies said. The Medscape article also delves into costs and other ethical issues arising from patients who refuse care.