Informed refusal
Encyclopedia
Informed refusal is a medico-legal
concept whereby a person can be said to have given refusal
to an intervention based upon an understanding of the facts and of the implications of not following a recommended diagnostic or therapeutic action. Informed refusal is linked to the informed consent
process, as a patient has a right to consent, but also may choose to refuse.
The individual needs to be in possession of the relevant facts as well as of his reasoning faculties, such as not being mentally retarded or mentally ill and without an impairment
of judgment
at the time of refusing. Such impairments might include illness, intoxication, drunkenness
, using drug
s, insufficient sleep
, and other health
problems. In cases where an individual is considered unable to give informed refusal, another person (guardian
) may be authorized to give consent on their behalf.
The concept grew out of and is similar to that of informed consent
, but much less commonly used and applied. In the United States of America
it is recognized in certain state law
s (in 2006: California
, Nevada
, Vermont
, and Michigan
) as well as in various court decisions.
As applied in the medical field, a physician has made an assessment of a patient and finds a specific test, intervention, or treatment is medically necessary. The patient refuses to consent to this recommendation. The physician then needs to explain the risks of not following through with the recommendations to allow the patient to make an informed decision against the recommendation. While in the past documentation of refusal of treatment has not been important, the widespread use of managed care, cost containment processes, as well as increased patient autonomy have created a situation where documented "informed refusal" is viewed as becoming more important When refusal of treatment may result in significant damage or death, the interaction needs to be documented to protect the care giver in a potential later litigation against the allegation that the recommendation was either not made or not understood. On occasion, a patient will also refuse to sign the "informed refusal" document, in which case a witness would have to sign that the informed process and the refusal took place.
The pregnant patient represents a specific dilemma in the field of informed refusal as her action may result in harm or death to the fetus. Ethicists disagree on how to handle this situation.
Law
Law is a system of rules and guidelines which are enforced through social institutions to govern behavior, wherever possible. It shapes politics, economics and society in numerous ways and serves as a social mediator of relations between people. Contract law regulates everything from buying a bus...
concept whereby a person can be said to have given refusal
Refusal
In horse riding, a refusal is the failure of a horse to jump a fence to which he/she is presented. This includes any stop in forward motion. A run-out is when the horse quickly slides past or "ducks out" of a fence instead of jumping it, without stopping forward motion.-Problems with...
to an intervention based upon an understanding of the facts and of the implications of not following a recommended diagnostic or therapeutic action. Informed refusal is linked to the informed consent
Informed consent
Informed consent is a phrase often used in law to indicate that the consent a person gives meets certain minimum standards. As a literal matter, in the absence of fraud, it is redundant. An informed consent can be said to have been given based upon a clear appreciation and understanding of the...
process, as a patient has a right to consent, but also may choose to refuse.
The individual needs to be in possession of the relevant facts as well as of his reasoning faculties, such as not being mentally retarded or mentally ill and without an impairment
Impairment
Impairment may refer to:* A medical condition that leads to disability* In accounting, a downward revaluation of fixed assets* In health, any loss or abnormality of physiological, psychological, or anatomical structure or function, whether permanent or temporary...
of judgment
Judgment
A judgment , in a legal context, is synonymous with the formal decision made by a court following a lawsuit. At the same time the court may also make a range of court orders, such as imposing a sentence upon a guilty defendant in a criminal matter, or providing a remedy for the plaintiff in a civil...
at the time of refusing. Such impairments might include illness, intoxication, drunkenness
Drunkenness
Alcohol intoxication is a physiological state that occurs when a person has a high level of ethanol in his or her blood....
, using drug
Psychoactive drug
A psychoactive drug, psychopharmaceutical, or psychotropic is a chemical substance that crosses the blood–brain barrier and acts primarily upon the central nervous system where it affects brain function, resulting in changes in perception, mood, consciousness, cognition, and behavior...
s, insufficient sleep
Sleep
Sleep is a naturally recurring state characterized by reduced or absent consciousness, relatively suspended sensory activity, and inactivity of nearly all voluntary muscles. It is distinguished from quiet wakefulness by a decreased ability to react to stimuli, and is more easily reversible than...
, and other health
Health
Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain...
problems. In cases where an individual is considered unable to give informed refusal, another person (guardian
Legal guardian
A legal guardian is a person who has the legal authority to care for the personal and property interests of another person, called a ward. Usually, a person has the status of guardian because the ward is incapable of caring for his or her own interests due to infancy, incapacity, or disability...
) may be authorized to give consent on their behalf.
The concept grew out of and is similar to that of informed consent
Informed consent
Informed consent is a phrase often used in law to indicate that the consent a person gives meets certain minimum standards. As a literal matter, in the absence of fraud, it is redundant. An informed consent can be said to have been given based upon a clear appreciation and understanding of the...
, but much less commonly used and applied. In the United States of America
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
it is recognized in certain state law
State law
In the United States, state law is the law of each separate U.S. state, as passed by the state legislature and adjudicated by state courts. It exists in parallel, and sometimes in conflict with, United States federal law. These disputes are often resolved by the federal courts.-See also:*List of U.S...
s (in 2006: California
California
California is a state located on the West Coast of the United States. It is by far the most populous U.S. state, and the third-largest by land area...
, Nevada
Nevada
Nevada is a state in the western, mountain west, and southwestern regions of the United States. With an area of and a population of about 2.7 million, it is the 7th-largest and 35th-most populous state. Over two-thirds of Nevada's people live in the Las Vegas metropolitan area, which contains its...
, Vermont
Vermont
Vermont is a state in the New England region of the northeastern United States of America. The state ranks 43rd in land area, , and 45th in total area. Its population according to the 2010 census, 630,337, is the second smallest in the country, larger only than Wyoming. It is the only New England...
, and Michigan
Michigan
Michigan is a U.S. state located in the Great Lakes Region of the United States of America. The name Michigan is the French form of the Ojibwa word mishigamaa, meaning "large water" or "large lake"....
) as well as in various court decisions.
As applied in the medical field, a physician has made an assessment of a patient and finds a specific test, intervention, or treatment is medically necessary. The patient refuses to consent to this recommendation. The physician then needs to explain the risks of not following through with the recommendations to allow the patient to make an informed decision against the recommendation. While in the past documentation of refusal of treatment has not been important, the widespread use of managed care, cost containment processes, as well as increased patient autonomy have created a situation where documented "informed refusal" is viewed as becoming more important When refusal of treatment may result in significant damage or death, the interaction needs to be documented to protect the care giver in a potential later litigation against the allegation that the recommendation was either not made or not understood. On occasion, a patient will also refuse to sign the "informed refusal" document, in which case a witness would have to sign that the informed process and the refusal took place.
The pregnant patient represents a specific dilemma in the field of informed refusal as her action may result in harm or death to the fetus. Ethicists disagree on how to handle this situation.