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At least 19 recordsLinked to original sources
PubMed1987

Treatment refusal among forensic inpatients.

Although the United States Supreme Court has not offered a definite opinion, some states have established the qualified right of involuntarily committed patients to refuse treatment. Controversy continues between psychiatry and law over what procedural protections should be provided to patients when therapists seek to override nonemergency refusal of treatment. The authors review Oregon's administrative approach and its application to the treatment refusal of 33 state hospital forensic patients. Patient characteristics, refusal patterns, and implications of treatment refusal are also described.

Adult↗
PubMed1983

Patients who refuse treatment in medical hospitals.

Treatment refusal in medical hospitals, despite the interest it has aroused among lawyers and ethicists, has been largely ignored by the medical profession. This study of the phenomenon in a number of medical and surgical settings has disclosed that refusal is a common occurrence. In this study, refusals were often precipitated by problems within the physician-patient relationship, although several interactive factors were usually involved. Physicians' responses to refusal tended to be undifferentiated with regard to the precipitants, depending more heavily on the medical urgency of the situation. Costs of refusal were measurable in terms of delay and increased expense when treatment was ultimately accepted and, less commonly, in terms of physical harm to the patient. These findings illustrate important strains in the modern physician-patient relationship and suggest that closer attention to factors underlying refusal may increase the rate of successful resolution.

Adult↗
PubMed1983

Systematic understanding of cancer patients who refuse treatment.

The refusal of treatment by cancer patients often takes place in a highly charged emotional context. Clinicians facing these situations frequently feel they are confronting an ethical dilemma involving whether to accept the patient's refusal or persuade the patient to a different position. However, most situations involving refusal of treatment involve issues of psychological distortions, interpersonal dysfunction, medical systems dysfunction, or psychiatric disorder, such as depression or organic mental disorder. By systematically reviewing these dimensions with the patient, many apparent dilemmas involving refusal of treatment will be resolved.

Adenocarcinoma↗
PubMed1988

Drug treatment refusal and length of hospitalization of insanity acquittees.

Thirty-three insanity acquittees who had refused drug treatment were matched to a sample of nonrefusing hospitalized insanity acquittees in an attempt to measure the effect of treatment refusal on length of hospital stay. No measurable effects on the length of hospitalization were found. However, upon comparing the amount of time under court jurisdiction spent in the hospital and on conditional release in the community, it becomes evident that refusers spent significantly greater proportions of time hospitalized than the average hospitalized insanity acquittee, who had less hospitalization and spent more time on conditional release. These differences do not seem to be related to the issue of treatment refusal.

Adult↗
PubMed2000

Treatment refusal: analysis of 15 cases.

BACKGROUND: In this paper, we investigate the reasons for treatment refusal at Linkou and Kaohsiung Chang Gung Memorial Hospitals, and offer ways to improve the doctor-patient relationship. METHODS: Cases were collected during a 2-year period according to the criterion of notification of "refused treatment" on consultation sheets, with a total of 1631 consultation sheets. All cases were discussed once a week in detail by psychiatrists and the consulting medical staff, and were followed up from 1 to 4 weeks. All cases were treated by the processes of informed consent and crisis intervention. The final results for the reasons of treatment refusal and psychiatric diagnoses were made by psychiatrists and the consulting medical staff. RESULTS: The number of cases compatible with the criterion was 15 (10 men and 5 women). The reasons for treatment refusal included poor communication, inadequate information, lack of competency, denial and shock reaction, reappearance of the suffered experience, and autonomy of patients. The distribution of psychiatric diagnoses included 8 with major depressive disorders, 2 with delirium, 1 with schizophrenic disorder, 1 with adjustment disorder, 1 with acute stress disorder (post-traffic accident), 1 with alcohol dependence, and 1 was deferred. After adequate processes of informed consent and crisis intervention, 12 persons accepted medical treatment. CONCLUSION: We should give patients adequate informed consent and crisis intervention to establish a good doctor-patient relationship and to respect the patients' autonomy for their choice of treatment.

Adolescent↗
PubMed1987

Factors related to drug treatment refusal in a forensic hospital.

Using the hospital records of 421 patients in a maximum-security forensic hospital, the authors explored the relationship between clinical factors and patients' receptiveness to or refusal of drug treatment. They found drug treatment refusal to be significantly related to a psychotic diagnosis in the absence of a personality disorder; in contrast, psychotic patients with personality disorders tended to be relatively compliant with drug treatment. Treatment refusers had significantly longer lengths of hospitalization that were not reduced by receipt of medication. Significant relationships were also found between treatment refusal and involuntary medication, use of restraints, and greater number of previous hospitalizations; between reasons for refusal and involuntary medication; and between history of substance abuse and previous incarceration.

Adult↗
PubMed1984

The right to refuse treatment and the movement for mental health reform.

The right to refuse treatment is the most controversial of the rights of mental patients, and usually polarizes the movement for mental health reform between providers of care and external activist reformers. A broad alliance supported earlier struggles for recognition of patients' rights, but most professionals oppose recognizing this most extreme right of treatment refusal. Professional opposition to treatment refusal is not based on a wide extent of actual refusal; rather it derives from a defense against challenges to professional and institutional autonomy, an opposition to legal interference, and a belief that the community as well as the patient must be protected. These three reasons for opposition are examined by reviewing studies of attitudes toward patients' rights, knowledge about patients' rights, and implementation of patients' rights. Finally, the implications of these studies for future directions in the movement for patients' rights are examined.

Dangerous Behavior↗
PubMed1996

Towards the right to be killed? Treatment refusal, assisted suicide and euthanasia in the United States and Canada.

This chapter describes some dominant trends of American and Canadian law in relation to treatment refusal, physician-assisted suicide and euthanasia. Although common law in both countries recognizes the right of patients to refuse treatment, problems have arisen, especially in the US, over treatment refusal on behalf of incompetent patients. One response has been to enact advance-directive legislation, promoting the use of living wills and proxy appointments. Courts have also specified criteria for withholding and withdrawing treatment from incompetent patients. The notion of a "right to die', developed in court cases on treatment refusal, is now being invoked to support the legalization of assisted suicide. Courts are generally reluctant to recognize an extention of this right. Debates and court cases following the recent initiative to legalize assisted suicide in Oregon and the Sue Rodriguez case in Canada's Supreme Court, which resulted in a special report of a Canadian Senate Committee, are of major importance for the development of law in this area.

Canada↗
PubMed1993

Cancer patients who refuse treatment.

The value of cancer treatment was assessed using a 'natural experiment' where patients who refused treatment served as no-treatment controls in a situation where withholding treatment to form a control group is unethical. Each cancer patient who refused treatment in Alberta, Canada between 1975 and 1988 was compared with five subjects who accepted treatment, matched on cancer site, age, number of cancers, and time period. Variables associated with treatment-refusal were included in Cox's proportional hazards model of survival, with death from cancer as the endpoint and deaths from other causes as censored observations. Treatment was refused at a rate of 7.5 per 1,000. One-third of patients who refused treatment had lung cancer and most had unstaged disease. Treatment refusal was associated with a difference in median survival of approximately nine months. Site-specific analyses showed a range of effects. Case fatality among the treated patients fell by approximately 10 percent during the 14-year study period. Even in advanced disease, treatment can result in improved survival. However, the results of this study must be interpreted with caution and cannot be generalized to all cancer patients.

Adolescent↗
PubMed1988

Autonomy and the right to refuse treatment: patients' attitudes after involuntary medication.

The courts' assumption that patients' refusals of treatment are based on autonomous decision making was evaluated by examining the opinions of 24 involuntarily medicated patients about their treatment. At discharge 17 patients felt that their treatment refusal had been correctly overridden by staff and that they should be treated against their will again if necessary. Patients who persistently disapproved of the decision to override their treatment refusal were highly grandiose, engaged in denial of psychotic proportions, and responded poorly to treatment. The results suggest that, for most patients, the decision to refuse psychotropic medication is a manifestation of the patient's illness and does not reflect autonomous functioning or consistent beliefs about mental illness or its treatment. Consequently treatment refusal should be considered primarily a psychotherapeutic issue and, in most cases, should be subject to clinical rather than judicial review.

Adult↗
PubMed1989

The right not to be treated or to refuse treatment.

The corollary to the right to refuse treatment is the requirement that, in general, informed consent be obtained before treatment. The Declaration of Lisbon recognises this: "The patient has the right to accept or to refuse treatment after receiving adequate information." The information to be given to the patient is of three kinds, but a special problem in relation to the doctrine of informed refusal places a special duty on the doctor to inform the patient about the possible consequences of refusing treatment. Related topics, such as refusal in part, refusal by a parent or guardian, the novus actus interveniens, the living will, and contributory negligence are touched upon.

Adult↗