Ethical and practical considerations on refusal of medical treatment

Refusal of medical treatment is among the most important rights of patients and a natural consequence of informed consent، although it can result in harm to patients or others and even the health care system. Treatment refusal may have various clinical manifestations whose recognition and proper understanding is essential to their management. In some cases the legal aspect is primarily dominant، such as when there is the possibility of harm to a third party. In other cases، for instance in absence of patient capacity، there are clear guidelines for decision-making. Major ethical challenges in the field of treatment refusal frequently pertain to capable patients، and this paper is mainly about the practical issues related to this group. The problems that these patients face are mostly due to improper physician-patient relationship or fleeting emotions. Caregivers should be prepared to deal with these issues and try their best to overcome obstacles and achieve patient satisfaction، with the exception of critical emergencies where treatment is carried out without consent. If all measures fail، patients’ refusal must be documented and other therapeutic interventions should be offered.