Pt refusal, extreme edition...

[Arctickat]

CYA Healthcare at its worst.

[triemal04]

Lets see here, the guy has his leg all but amputated, but doesn't want immediate care. We don't know what his reason was because the OP admits he's forgotten it. But, it's pretty fair to believe that there was no good reason. Thus, he's not making a decision competently. But, that's fine, you get to have an opinion, too,

No we don't force everyone to go against their will in our system. The other side of the coin is the I live and work in one of the most litigious states in America. So sometimes the people that make the rules are going to err on the side of caution. That's why we have someone above us in the chain who can give orders and take the liability off of us.

It's also why I took the time to make the point that other system policy's and procedures would likely vary.

Sweet holy motherfuck! Are you suggesting that because someone makes a poor decision that they are incompetant to make any decision? Are that the act of making a bad decision is a sign of mental incompetance as far determining the ability to refuse goes? Oh wow...

It doesn't matter if you work in California (or wherever); if someone is competant to refuse you can't force them. You can, and should give them every opportunity to change their minds, but in the end the choice is theirs. Document document document. And yeah. You'll still run the risk of being sued, maybe successfully. But it's better than the alternative.

Some years ago I had a patient with chest pain in the ER. Wide mediastinum on the portable chest. After a trip to the CT scanner, we had a diagnosis of an aortic dissection. After being told what was going on, the patient just wanted his/her sons to take him/her home. Several people tried their best to explain the risks, but in the end the patient signed out AMA and went home to their death. You have to respect the autonomy of a well informed, competent patient and let them make their decision. Sometimes, we as health care providers, get it in our minds that we know what is best for people. That's a slippery slope, but I'm not sure I always know what's best for me let alone a well informed, competent person making a decision about their healthcare.

Maybe a topic for a different thread, but I see that as a completely different set of circumstances. Instead of an accident you have a natural event occuring. If they decide that they don't want to ungergo surgery with the associated risks, are comfortble with their own mortality and would prefer to spend their last time at home with family...I have zero problem with that.

As before they should still have every chance to change their mind, but...depending on the person, whoes to say that wasn't the better choice for them?

[chbare]

In each situation, the patient is experiencing a potentially life threatening issue and making an informed decision. Regardless of the circumstances, both patients are making decisions that many not be in their best interest depending on the context and how ones defines "best interest." In any event, both people are making informed decisions to refuse treatment.

[Just Plain Ruff]

Lets see here, the guy has his leg all but amputated, but doesn't want immediate care. We don't know what his reason was because the OP admits he's forgotten it. But, it's pretty fair to believe that there was no good reason. Thus, he's not making a decision competently. But, that's fine, you get to have an opinion, too,

No we don't force everyone to go against their will in our system. The other side of the coin is the I live and work in one of the most litigious states in America. So sometimes the people that make the rules are going to err on the side of caution. That's why we have someone above us in the chain who can give orders and take the liability off of us.

It's also why I took the time to make the point that other system policy's and procedures would likely vary.

Wow, Can someone say "drank the KoolAid?" with that line of thinking.

[ERDoc]

Lets see here, the guy has his leg all but amputated, but doesn't want immediate care. We don't know what his reason was because the OP admits he's forgotten it. But, it's pretty fair to believe that there was no good reason. Thus, he's not making a decision competently. But, that's fine, you get to have an opinion, too,

No we don't force everyone to go against their will in our system. The other side of the coin is the I live and work in one of the most litigious states in America. So sometimes the people that make the rules are going to err on the side of caution. That's why we have someone above us in the chain who can give orders and take the liability off of us.

It's also why I took the time to make the point that other system policy's and procedures would likely vary.

Since you are new here, I'll give you a little personal background. I grew up and trained in NY, the litigation capital of the world so I know a little about litigation. It doesn't matter whether you feel a person has a good reason or not, if they have the capacity to make their own decisions, no matter how stupid it may seem to us, they have the right to do so. It has nothing to do with policies or protocols. It has to do with the law and the law says that if someone has the capacity to make their own decisions, you cannot make them go otherwise it is battery, assault and/or kidnapping. It is not my opinion, it is legal jurisprudence.

[Kiwiology]

... the law says that if someone has the capacity to make their own decisions, you cannot make them go otherwise it is battery, assault and/or kidnapping. It is not my opinion, it is legal jurisprudence.

Then what do you call me being tied up, gagged and stuffed into the trunk of your car?

Shame you didn't drive across state lines, then I could have the FBI come after you because that is a federal crime.

Oh and for a Consultant Physician your car kinda sucks, I disappoint ... and lets not even go near your taste in music

[ERDoc]

Then what do you call me being tied up, gagged and stuffed into the trunk of your car?

Foreplay.

and lets not even go near your taste in music

You have something against classic freestyle?

[Bieber]

People have the right to make decisions that we disagree with or which go against our professional recommendations, insofar as they are not intent on harming themselves. Additionally, not wanting to live isn't the same as wanting to hasten your own demise (and we can only take people against their will in one of those situations).

I agree with Dwayne that it's discouraging to see people engage in tactics which subtly or overtly take the rights out of the hands of their patients. I was encouraged at one time to not ask patients if they "would like to go to the hospital via EMS" but instead to say "what hospital can I take you to" because supposedly the former might encourage them to refuse while the latter implies that they have no option. It was one of the most disgusting pieces of advice I was ever told and I absolutely refuse to give my mentally competent patients any reason to think that they're not the bosses of the show. I don't even like to use scare tactics, even when I really think they should go. My job is to give them the facts, my recommendation, and to let them make the decision for themselves.

Dwayne, did you consider seeing if the patient would consent to you taking him to his wife or meeting her en route?

[Arctickat]

Is suicide an illegal act where you are? I ask because here it is not. A person has the right to take his/her own life and can not be incarcerated for an unsuccessful attempt. In other words, if we force a suicidal person to the hospital, it's kidnapping and forcible confinement.

not wanting to live isn't the same as wanting to hasten your own demise (and we can only take people against their will in one of those situations).

[Bieber]

Kat, suicide is considered a sign of psychiatric derangement and a suicide attempt or making suicidal statements is grounds to be placed under a protective psychiatric hold here where I am (and I believe all the United States). It's considered abandonment to leave a patient who is a credible threat to themselves on scene.

Don't agree with it a hundred percent, but it is what it is.