Incapacitated Refusal

 
Sometimes patients who lack decision-making capacity
refuse treatment that would be in their best interests. Imagine, for example, a
patient suffering from acute schizophrenia who adamantly and persistently refuses
to take antipsychotic medication that would relieve his symptoms. And suppose,
further, that this patient poses no danger to himself or others, but that his
mental illness prevents him from understanding his diagnosis as well as his
likely prognosis with and without the treatment. Should a provider treat such a
patient over his objections?

My reflections begin with the observation that in most
cases of this kind, physicians tend to respect the patient’s incapacitated
refusal, either by honoring it, or, at the very least, by treating it with
great seriousness. Why? The simple answer is a legal one: in New York and many
other states, it is against the law to treat patients over their objections
except in cases in which the treatment will prevent them from endangering themselves
or others. My interest here, though, is ethical rather than legal: what ethical
justification can we offer for this practice?
Answering this question is challenging in part because
honoring incapacitated refusals is not obviously justifiable by appeal to any
of Beauchamp and Childress’s famous four principles of biomedical ethics: The
decision to honor an incapacitated refusal has nothing to do with the fair
distribution of benefits and burdens, and so it is not a ma...

Source: blog.bioethics.net - November 4, 2019 Category: Medical Ethics Authors: Bioethics Today Tags: Health Care autonomy beneficence capacity syndicated Source Type: blogs