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Refusing consent

“Although the term ‘consent’ implies acceptance of treatment, the concept of informed consent applies equally to refusal of treatment or to choice among alternative treatments. Competent patients have the right to refuse treatment, even when the refusal will result in disability or death.”33

Consent law would be completely pointless if it did not protect a patient’s right to refuse treatment. Doctors may not override a patient’s refusal of treatment simply because they think it is a foolish or illogical decision. And they may not disregard patients who choose not to take their advice.

If the patient is not giving clear reasons for refusing the proposed treatment, it may be worth probing a little further to find out whether she/he is harbouring hidden fears and anxieties that could be assuaged with further information and discussion. Any such discussion, however, must be conducted sensitively and respectfully, otherwise it could be construed as coercion.

Occasionally, it may be appropriate to assess the patient’s decisional capacity, but the patient’s refusal should never, in itself, be taken as evidence of lack of decisional capacity. If the patient is capable, she/he should be given all material information to ensure that the refusal is truly informed. Available alternatives should then be offered, with a reminder that the patient may change his/her mind.

Withdrawing consent

Patients with decisional capacity may also withdraw consent for continuing treatment. If, during a procedure, a patient indicates that she/he wants you to stop, you should stop the procedure as soon as it is safe to do so and then explain the consequences of not proceeding further, without implying coercion. It is important to let patients know that stopping a procedure will not compromise their care.

The rights of patients who lack decisional capacity should also be respected in this regard. If they indicate that they want a procedure to stop because they are in pain or discomfort, their wishes should be complied with, as above.