Patients who refuse treatment in medical hospitals
P. S. Appelbaum and L. H. Roth
Treatment refusal in medical hospitals, despite the interest it has aroused
among lawyers and ethicists, has been largely ignored by the medical
profession. This study of the phenomenon in a number of medical and
surgical settings has disclosed that refusal is a common occurrence. In
this study, refusals were often precipitated by problems within the
physician-patient relationship, although several interactive factors were
usually involved. Physicians' responses to refusal tended to be
undifferentiated with regard to the precipitants, depending more heavily on
the medical urgency of the situation. Costs of refusal were measurable in
terms of delay and increased expense when treatment was ultimately accepted
and, less commonly, in terms of physical harm to the patient. These
findings illustrate important strains in the modern physician-patient
relationship and suggest that closer attention to factors underlying
refusal may increase the rate of successful resolution.
