Refusing consent
If the patient is not giving clear reasons for refusing the proposed treatment, it may be worth probing a little further
Consent law would be completely pointless if it did not protect a patient’s right to refuse treatment. Doctors cannot override a patient’s refusal of treatment simply because they think it is a foolish or illogical decision. But neither can clinicians 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 they are 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 capacity, but the patient’s refusal should never, in itself, be taken as evidence of lack of capacity. If the patient is capable, they 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 can change their mind.
Scenario 6
Mrs D is 42 and has recently discovered a lump in her breast. She is told that malignancy cannot be excluded and an urgent referral to a specialist is required. She asks the GP to defer the referral, explaining that her daughter is currently preparing for important exams in five weeks time and she does not want to cause her any anxiety. Dr F, her GP, cannot understand how she can take such a risk but it is clear on talking to her that she fully understands the implications of her decision. Dr F records his findings along with Mrs D’s reasons for not agreeing to an immediate referral.