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Ethical Dilemma Investigative Brief Tyra Rice Healthcare Policy, Law and Ethics Professor Chad Moretz 11/26/23 1

Ethical Dilemma Investigative Brief: A Patient Refusing Needed Consultation/Treatment A 50-year-old male was continually experiencing flank and back discomfort and had to consult with his family physician (FP) due to the intensifying pain. The FP conducted a urine culture, urinalysis, and a physical examination, revealing traces of urinary tract infection (UTI) and blood in the urine. The FP advised the patient to consult a urologist for additional assessment, but the patient declined (ProAssurance, 4). In this case study, the relevant ethical/moral principles are autonomy, nonmaleficence, and beneficence. Regarding autonomy, the patient has the right not to follow the FP's orders or instructions, although the FP thinks it would be medically necessary. Concerning nonmaleficence, the FP should assess the possible risks of refusing to consult a urologist (worsening health condition) against the potential benefits of consulting a urologist (obtaining more specific, expert treatment). Then, in terms of benevolence, the FP thinks that the patient should consult a urologist since this specialist could more effectively treat the UTI. From the viewpoint of utilitarianism, the most appropriate response ensures that the patient's overall well-being, safety, or happiness is maximized (Pozgar, 3). Thus, the FP must encourage the patient to consult a urologist, continually stressing the possible benefits for the patient's well-being and health. But, at the same time, the FP should allow the patient to exercise his right to decline treatment. If the patient stubbornly refuses treatment, the FB must give him definite, understandable information regarding the possible risks of his choice and monitor his 2

illness thoroughly (Lo, 1). In essence, the objective of the FP must be to uphold the overall well- being and happiness of the patient while at the same time recognizing the patient's autonomy to make decisions about his health. On the other hand, deontologists would claim that the patient’s autonomy should come first or be prioritized (Pozgar, 3). However, although this should be the case, the FP must not neglect the possible adverse events that could arise from declining treatment. In other words, the FP should strive to balance his duties to ensure that the patient receives the necessary treatment and the patient's right to refuse one. Using these ethical/moral theories, the following solutions could potentially resolve the ethical dilemmas in this case. One is properly communicating with and educating the patient. It is essential to ensure that the patient is completely informed of and understands his illness, the potential treatments, and the possible outcomes of not receiving the needed care (Krause & Boldt, 2). It is vital to attentively listen to why the patient does not want to consult a urologist and empathetically respond to his concerns. The FP should allow the patient to convey his preferences and uncertainties freely. The second is involving the patient in planning for his treatment. Discuss the possible treatments clearly with him and consider his values and priorities. If possible, encourage his family members or other significant others to be involved in his treatment as a form of support network (Lo, 1). Third, seek consultation, advice, and guidance from colleagues. The FP would more easily or quickly resolve the ethical dilemma if another healthcare professional who could have experienced the same problem would give advice. It is also advisable to seek assistance from outside consultants or hospital ethics boards (Krause & Boldt, 2). And lastly, the FP must monitor the patient's condition and encourage him to attend follow-up appointments regularly. 3

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Sources 1. Bernard Lo. 2013. Resolving Ethical Dilemmas: A Guide for Clinicians. https://www.google.com.ph/books/edition/Resolving_Ethical_Dilemmas/Yfkbnq5O8koC ?hl=en&gbpv=0 2. Franziska Krause and Joachim Boldt. 2017. Care in Healthcare: Reflections on Theory and Practice. https://www.google.com.ph/books/edition/Care_in_Healthcare/DFM7DwAAQBAJ?hl=e n&gbpv=0 3. George D. Pozgar. 2014. Legal and Ethical Issues for Health Professionals. https://www.google.com.ph/books/edition/Legal_and_Ethical_Issues_for_Health_Prof/bz b3BQAAQBAJ?hl=en&gbpv=0 4. ProAssurance. 2017. When Patients Refuse Treatment: Medical Ethics Issues for Physicians. https://www.norcal-group.com/library/when-patients-refuse-treatment- medical-ethics-issues-for-physicians 4

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