What to do when a patient refuses evidence-based treatment: An ethical dilemma

Abstract

Ethical dilemmas are posed when patients do not agree or comply with health professionals' advice. This case study discusses the ethical dilemma and values which emerged following a patient's refusal to follow safe swallowing advice in a neuro-critical intensive care unit. Central to this dilemma are the principles of informed refusal of care (involving autonomy and patients' preferences) and the professional's desire to protect the patient from harm. In the environment of a neuro-critical intensive care unit, expressing a beneficent paternalism may enable the health professional to tie all the loose ends of a complex case where different principles clamour to be heard. Complex ethical dilemmas in neurorehabilitation require communication, discussion and reflection on ethical theories and principles.