Informed Refusal

Informed refusal is an attempt to balance the provider's duty to provide care with respect for patient or resident autonomy and right to self-determination—a balance that has been evolving over time and varies among both state statutory and case law. Regardless, every provider will on some occasion be faced with a person who refuses treatment, and healthcare risk managers are tasked with ensuring that staff are aware of their obligations and are prepared to comply with their organization's policies and procedures related to handling refusal of medical treatment.

Although recent literature is sparse on the rates of treatment refusal, a landmark study from 1983 found that 19% of the study's population initially refused at least one treatment or diagnostic procedure over an eight-week period, and the study authors suggested that rate underrepresents the total percentage due to transfers and timing of admission or discharge. Psychological factors and problems in communication were identified as the primary and secondary reasons for refusal, respectively. The majority of the refusals resulted in no treatment given (34%), followed by a delayed acceptance of proposed treatment (31%). (Appelbaum and Roth)

Individuals may refuse medical treatment for a multitude of reasons, whether they disagree with the course of action; they fear possible outcomes or believe the risks do not outweigh possible benefits; they have religious, cultural, familial, or financial concerns related to the proposed treatment; or their current emotional distress affects their ability to make a decision. When providers understand the reason behind refusal, they may be in a...