Refusal Of Medical Treatment Research Articles

의사결정능력 있는 미성년 환자와 의사의 설명의무

Medical treatment is a therapeutic activity aimed at improving the patient’s health, but it is an invasive activity that involves risks to the patient's body and may unintentionally cause side effects or sequelae. Therefore, the patients consider seriously and decide whether to accept or refuse medical treatment based on the professional explanation of the doctor in charge of the medical treatment. However, this expectation is based on the assumption that the patient has sufficient capacity to understand the doctor’s explanation and make judgments, so it should be carefully examined whether the same treatment can be achieved in the case of someone who lacks capacity to understand and make judgments. The Supreme Court Decision 2020Da218925 delivered on March 9, 2023 decided that a minor patient with decision-making capacity can have the right to self-determination, so a doctor is obligated to explain medical treatment to a minor patient in principle, but such explanation may be recognized as fulfilling the doctor’s obligation of explanation by delivering the explanation to the minor through a parent or legal representative, or the doctor must explain medical treatment directly to the minor patient only if there are special circumstances, and this article reviews the reasoning and judgment of the Decision. The Decision is significant in that the Supreme Court has decided for the first time that, in principle, a doctor is obligated to explain medical treatment to a minor patient as long as the patient has decision-making capacity, even if the patient is a minor and in principle, a doctor may fulfill the duty of explanation to a minor patient by indirect explanation through a parent or legal representative, but there are exceptions to this principle, and the decision explicitly provides two types of examples of such cases. However, as long as a minor is recognized as having the same decision-making capacity as an adult patient, the direct explanation by the doctor to the minor patient, rather than the indirect explanation by the parent or legal representative, should be the principle method of fulfilling the duty of explanation, it would be more appropriate to allow indirect explanation to be permitted as an exception in cases where there are special circumstances that make such direct explanation difficult.

Medical staff’s sense of awareness of informed consent for adolescent cancer patients and the need for decision-making support practiced from the perspective of trauma-informed approach

It has not been established how to assess children’s and adolescents’ decision-making capacity (DMC) and there has been little discussion on the way their decision-making (DM). The purpose of this study was to examine actual situation and factors related to difficulties in explaining their disease to adolescent cancer patients or obtaining informed consent (IC). The cross-sectional questionnaire survey was conducted. Physicians who have been treating adolescent cancer patients for at least five years answered a self-administered questionnaire uniquely developed about clinical difficulties in explaining, IC and factors related patient’s refusal of medical treatment (RMT). Descriptive statistics for each item and a polychoric correlation analysis of the problems and factors related to the explanation were conducted. As a result, fifty-six physicians were participated (rate of return: 39%). Explaining the disease and treatment to patients (83.9%), IC to patients (80.4%), and explaining the disease and treatment to parents (78.6%) was particularly problematic. Difficulties to provide support related with patient’s refusal of medical treatment and to explain disease and treatment for patient and parents were related to difficulties obtaining IC for the patient. Conclusion: There are clinically difficult to explain for the patient or parents and to obtain IC for the patient. It is necessary to establish a disease acceptance assessment tool for the adolescence generation so that it can be applied in the field.

The Right to Be Ill: Refusal Of Medical Treatment v. Public Health In a Democracy

Debates regarding health and health care generally involve questions regarding whether there is a right to -either. But in a democracy do individuals have a right to refuse medical treatment? The 2019 Covid pandemic raised this question as democracies sought to balance individuals with medical mandates such as the wearing of masks or vaccines. This article examines that question asking whether there is a right to be ill and to refuse force medical treatment in the case of infectious diseases that are life threatening. The article will conclude that in most cases competent adults have a right to refuse medical treatment and be ill, yet such a right has to be balanced against a host of factors supporting the preservation of the life of others.

A STUDY OF THE LEVEL OF AWARENESS,CAPACITY AND CONSENT AMONG EMERGENCY HEALTHCARE WORKERS IN A TERTIARY CARE HOSPITAL IN KOLKATA.

Introduction: Most patients lack the medical competency to grasp the optimal course of treatment for their health, thus doctors and nurses must constantly assess whether patients can consent to tests and treatments. Patients who refuse to go to the hospital or who do not comprehend what medical activity is benecial to their health frequently require all health care personnel to make these kinds of decisions. Thus, every healthcare provider must be aware of the risk that some of their choices may one day be criticised or reconsidered on the grounds that they neglected to offer critical therapy to a person with limited capacity because they picked an unfavorable treatment route. Patients who have self-harmed refuse medical treatment when it is detected, which is an increasingly concerning trend in today's culture. Consequently, it's vital that medical professionals in tertiary care facilities across the country are well-versed in capacity and consent difculties such as the above metropolises like Kolkata, Mumbai, Chennai. To conduct research into emergency healthcare providers' awareness of abi Aim: Materials And Methods: lity and consent. Peerless Hospital researchers interviewed 84 members of the emergency medical services from July to October using a cross-sectional questionnaire (4 months). The B.K. Roy Research Center and Peerless Hospital are both located in Kolkata, West Bengal, India. SPSS 24.0 and GraphPad Prism 5 were used to perform statistical analyses on the data imported into Microsoft Excel. Unpaired proportions were compared using Chi-square or Fischer's exact tests, depending on whether statistical signicance was required. We found that association of Q1 vs. group was Results: statistically signicant (p=0.0015). Association of Q2 vs. group was not statistically signicant (p=0.2002). Association of Q3 vs. group was statistically signicant (p=0.0463). We came to the conclusion that the vas Conclusion: t majority of emergency medical technicians lacked statistically meaningful information.

On the Status of Rights

On the Status of Rights

Refusal of medical treatment by older adults with cancer: a systematic review.

The literature about the factors associated with cancer treatment refusal, especially by the older patients is scarce. Therefore, this study aimed to identify predictive factors associated with treatment refusal by older patients with cancer. A systematic review was conducted using three databases, Medline, Web of Science, and Scopus with the key concepts, "refusal treatment" and "cancer" and "decision making" and "elderly" or "aged". The search took place in July 2020 and it included articles published in the last 5 years. Of the 211 articles found, 22 were included in the review. Most studies have focused on head and neck and breast cancer treatment decisions and used a quantitative design. The majority of studies evaluated refusal of surgery interventions. Important factors associated with refusal cancer treatment include gender, marital status, race, having government insurance, advanced cancer, poor performance status (cancer stage III or IV) and Charlson Comorbidity Index ≥2. Thus, there are socio-demographic and clinical variables associated with treatment refusal. More studies with the elderly are needed. Understanding these factors may be useful to recognize situations where active education and support can help elderly patients accept optimal care.

Allowing Competent Children in South Africa to refuse Medical Treatment: Lessons from England

This article considers the question whether the right of children to consent to medical treatment includes the right to refuse medical treatment, as is the case with adult patients. If this question is answered in the affirmative, a second question arises, namely whether the protection of this right of children is as strong as the protection provided to their adult counterparts. More particularly, do children have the right to refuse medical treatment if that refusal is considered to be unreasonable or irrational by the child’s parents or doctors? If this question is answered in the negative, a third question is whether the differential approach to consent by child and adult patients is justified. In the first part of the article, the position in English law is explored. In the second part of the article, the South African legislative framework, particularly the Children’s Act 38 of 2005 and the National Health Act 61 of 2003, is considered. This is done against the background of international and regional human rights instruments and the Constitution of the Republic of South Africa, 1996. The lessons learned from the developments in English law are used to suggest a way forward in South African law.

Reformed Theology and Conscientious Refusal of Medical Treatment

AbstractTraditionally, healthcare workers have had the right to refuse to participate in abortions or physician-assisted suicide, but more recently there has been a movement in white Evangelical circles to expand these rights to include the refusal of any treatment at all to same-sex couples or their children, transgender individuals, or others who offend the provider’s moral sensibilities. Religious freedom of conscience exists in an uneasy tension with laws protecting equal rights in a liberal polity, and it is a particularly fraught question in the context of medicine, where providers’ consciences must be balanced against patients’ rights to access appropriate care. This article examines the refusal of care to classes of people, usually classes defined by various sexual issues with which the caregivers disagree. This expands conscientious refusals from the traditional concept of responses to actions and instead directs it at specific types of people. The article draws on Reformed thought to argue that such refusals are not justified and are, in fact, both a profound misreading of Christian morality and a new and dangerously expansive account of the right to conscientious refusal in medicine.

Refusal of animal-derived medical products in a paediatric setting: Ethical issues.

Many medical products that are widely available and commonly used are of animal origin, which can be problematic for those who identify as followers of a particular religion, or have moral commitments or dietary preferences that prohibit or restrict the ingestion of animal products. Given that people are becoming more conscious of the products they ingest, however, we suspect this might be an issue in the foreseeable future, particularly in a multicultural and diverse community like Toronto, Canada. Failure to provide services sensitive to these beliefs and preferences may result in a refusal of medical treatment. In this paper, we aim to identify and explore issues relating to the refusal of animal-derived medical products in paediatric settings by exploring three clinical cases.

Right to Refuse Medical Treatment in Taiwan: Focusing on Life Insurance Contract against Death

Right to Refuse Medical Treatment in Taiwan: Focusing on Life Insurance Contract against Death

132 A Survey of Non-consultant Hospital Doctors’ Knowledge and Understanding of the Legal Status of Advance Care Directives in Ireland

Abstract Background The legal status of advance care directives (ACDs) in Irish law, as they pertain to current clinical practice, is a relatively new topic to healthcare staff. This project aimed to assess current understanding in non-consultant hospital doctors (NCHDs). Methods An online survey was conducted with NCHDs across a range of disciplines to ascertain current knowledge of the legal parameters of ACDs. Descriptive analysis of data was conducted in Excel. Results The survey was completed by 183 NCHDs. Of respondents 93.99% (n=172) were familiar with the term advance care directive and 41.53% (n=76) had encountered one in clinical practice. Their current legal status in Ireland was not known to 58.47% (n=107). That to be considered legally binding an ACD must be in writing was understood by 63.39%, but 58.47% (n=107) were unsure if a solicitor is required to draft one. Refusal of medical treatment as an application for ACDs was appreciated by 79.78% (n=146), however 38.89% (n=73) erroneously believed medical intervention could be requested in an ACD, with a further 30.6% (n=56) unsure. Current guidance sets out that only specific situations may be contained within an ACD, however 77.6% (n=142) of respondents believed a general stipulation could be documented, 25.14% (n=46) did not know if cognitive function affected the legality of an ACD, 95.08% (n=174) of respondents would attend formal training on ACDs if provided by their place of work. Conclusion Despite being enshrined in current legislation the legal status of advance care directives, their definition and criteria to be considered legally binding are very poorly understood by NCHDs. Guidance and education are crucial to the future protection of both patients and doctors with regards the execution of advanced care directives as prescribed by law.

A review and analysis of new Italian law 219/2017: \u2018provisions for informed consent and advance directives treatment\u2019

BackgroundIn December 2017, Law 219/2017, ‘Provisions for informed consent and advance directives’, was approved in Italy. The law is the culmination of a year-long process and the subject of heated debate throughout Italian society. Contentious issues (advance directives, the possibility to refuse medical treatment, the withdrawal of medical treatment, nutrition and hydration) are addressed in the law.Main textWhat emerges clearly are concepts such as quality of life, autonomy, and the right to accept or refuse any medical treatment – concepts that should be part of an optimal relationship between the patient and healthcare professionals. The law maximizes the value of the patient’s time to decide. Every patient is allowed to make choices for the present (consenting to or refusing current treatment) as well as for the future, conceived as a continuation of the present, and to decide what comes next, based on what he/she already knows. The law identifies three distinct but converging paths towards the affirmation of a care relationship based on reciprocal trust and respect: the possibility to consent to or refuse treatment, the shared care planning, and advance directives.ConclusionsThe fundamental point to emerge from the new Italian law is that consensus is an essential connotation of the treatment relationship. Consensus is not limited to the acceptance/rejection of medical treatment but is ongoing. It is projected into the future through shared care planning and advance directives which act as tools for self-determination and the manifestation of the beliefs and preferences of persons unable to express their will. These principles are in line with the idea of appropriate care as evaluated from two different perspectives, one of scientific adequacy and the other commensurate with the individual’s resources, fragility, values, and beliefs. Surely, however, the new law is not the end of the matter on issues such as conscientious objection, which is deeply rooted within the Italian cultural and political debate. In this regard, healthcare institutions and policymakers will be called upon to develop and implement organizational policies aimed at the management of foreseeable conscientious objection in this field.

The legal situation of a physician when parents refuse treatment on behalf of a minor patient

Abstract Introduction: Consent to or refusal of medical treatment is one of a patient’s basic rights. Medical law in this matter includes special rules regarding minors. This article comments on the legal regulations concerning the obligations and rights of physicians, parents and their dependents in the consent process. Materials and methods: The research material primarily involved sources of Polish law, current judgments, and practical problems. The selected method relied on the analysis of legal acts. The role of guardianship courts that can override parental authority to protect the well-being of the child, has been subjected to analysis. The article contains an interpretation of the regulations in the context of specific clinical cases, such as a life-threatening emergency, so that the physician does not become exposed to civil, criminal or disciplinary liability. Results: Consent to medical treatment is an elementary expression of patient autonomy. A statutory representative’s refusal for health service can be articulated in any way. The law does not define if it is necessary to obtain permission from both or just one of the parents. An exception to the rule of permission for medical intervention is to direct the case to the guardianship court in order to obtain the proper permits. This decision overrides parental authority. Authorized people can also give their permission for medical intervention after the treatment (ex-post consent). Conclusions: The unclear regulations that describe the whole procedure cause difficulties in practice for doctors. It is also uncertain where the regulations of the family and guardianship code cross over parental authority. The current juridical state creates a risk to doctors of civil, penal and disciplinary penalties.

Mental capacity as a medicolegal prerequisite for consent or refusal of medical treatment

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It Will Only Hurt a Little Bit: Compulsory Vaccination and the Right to Refuse Medical Treatment under the New Zealand Bill of Rights Act 1990

New Zealand law prioritises the right of parents to refuse vaccination over the interests of the wider public in preventing infectious diseases. As a result, poor immunisation rates leave the population prone to outbreaks of vaccine preventable diseases. In contrast, Australia has obtained high levels of immunisation coverage by introducing vaccination requirements for receiving government benefits and enrolling in early childhood centres. This paper suggests that adopting the Australian vaccination model would be a viable method of improving New Zealand’s immunisation rates and would likely be a demonstrably justifiable limit on the right of parents to refuse medical treatment under s 11 of the New Zealand Bill of Rights Act 1990.

Advance directives from haematology departments: the patient\u2019s freedom of choice and communication with families. A qualitative analysis of 35 written documents

BackgroundIn France, advance directives are favourably perceived by most of the population, although the drafting rate is low. This ambivalence is challenging because advance directives are meant to promote the autonomy and freedom of choice of patients. The purpose of this study was to analyse the content of advance directives written by patients suffering from malignant haemopathies to better understand how patients put them into practice. These could be relevant as early as the initial diagnosis of haematological malignancies because of the uncertain course of the disease.MethodsThis was a multicentre, qualitative, descriptive study. The advance directives written by patients with malignant haemopathies treated in one of the six French hospital departments were included in the study from 01/06/2008 to 15/04/2016. A thematic analysis of the advance directives was performed by two researchers: a senior haematologist and a research assistant.ResultsThe median age of the patients was 69. Most were women (sex ratio: 0.59), living as a couple (57%), with lymphoid pathologies (66%), who were still alive two years after the instructions were written (63%) and had nominated a health care proxy (88.6%). Free texts (62.9%) were richer in content than pre-defined forms. The advance directives were used in three ways: for a purely legal purpose, to focus on medical treatments or actions, or to communicate a message to the family. Three main themes emerged: (1) refusal of medical treatment (100%), in which patients express refusal of life-sustaining care (97.1%). The actual treatments or the moment when they should be limited or stopped were not always mentioned in detail. (2) A desire for effective pain relief to avoid suffering (57.1%) and (3) messages for their family (34.3%), such as funeral arrangements (17.1%) and messages of love or trust (14.3%).ConclusionsPatients who write advance directives are not necessarily at the end of their lives. Their content mainly conveys treatment wishes, although patients also use them to pass on personal messages to their close family. This emerging role of advance directives to communicate messages within the family should be valued, even if it is not their original purpose.

,,,The Mature Minor Doctrine: Can Minors Unilaterally Refuse Medical Treatment?

,,,The Mature Minor Doctrine: Can Minors Unilaterally Refuse Medical Treatment?

Hemophagocytic lymphohistiocytosis in a patient with human immunodeficiency virus infection: A case report.

Hemophagocytic lymphohistiocytosis (HLH), also termed hemophagocytic syndrome, is a severe, life-threatening inflammatory condition that results from an excessive, prolonged and ineffective immune response. The syndrome occurs due to overactive macrophages from the bone marrow or lymph tissue that phagocytose erythrocytes leukocytes and platelets. HLH in a patient with human immunodeficiency virus infection has rarely been studied. The present case study described an uncommon case of this syndrome in combination with human immunodeficiency virus infection in a patient, who eventually succumbed to severe infection and multiple organ failure following the refusal of medical treatment.

Risk Management for a Resident Who Won’t Follow Medical Advice

Risk Management for a Resident Who Won’t Follow Medical Advice

A universalização dos Direitos Humanos, o direito à saúde e a saúde pública

O artigo trata do tema da universalização dos direitos humanos à luz de uma leitura do direito à saúde feita a partir de sua coletivização, representada pelo fenômeno da saúde pública. Depois de considerações teóricas sobre todos os temas envolvidos, o desenvolvimento culmina no exame de dois casos práticos: o infanticídio indígena e a recusa de tratamento médico por religiosos.