Patient with Dementia's Right to Refusal - page 2

by oblivionenigma

Hello! I have a bit of an issue. There are certain patients I often take care of who have profound dementia--to the point of requiring hand-over-hand assistance for eating, unable to consistently reposition self in bed, etc--in a... Read More


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    Is this a SNF-specific thing, like the "no restraints" rule? I work in acute care, on the psych C&L service at a large academic medical center, and a pretty good chunk of what we do all day is evals on individuals to determine whether or not they have capacity to refuse tx. I've never heard anyone suggest that there could be such a thing as a person having the legal right to consent or withhold consent for treatment, or anything else, despite being, let's say, for the sake of discussion, profoundly demented.

    I would be v. surprised if this is, in fact, "the law" in whatever state the OP is in. And if it simply company policy, I also would question whether the legal counsel has been sufficiently involved. This is going to come back to bite the facility at some point ...
    Sadala and oblivionenigma like this.
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    I think the OP gets the point that an advanced dementia patient can no more refuse their care than can a 5 year old.

    What they often can do, however, is to demonstrate to us those things in our POC which are frightening, unpleasant, or uncomfortable for them as that is often when they act out. The patient may not be able to refuse an intervention but we as professionals can certainly determine when an intervention is more problematic than effective. When we discover those things we can discuss them with the care team and family to devise a new and improved plan for the patients care and comfort.

    Good luck.
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    Quote from jadelpn
    Then the company policy needs to have more than "a patient can't refuse". Because then you could be brought up on neglect charges. Can this be brought to administration with a suggestion that their (or parent company's) legal team give direction, and if it is found that "everyone has the right to refuse" then ask for some sort of plan. ie: If patients declines turning and repostioning more than 2 days, then family meeting will be called to discuss other options for care" or something to that nature. There are lots of other legal guardianship type of things that state a patient can not refuse--but your company's attorney can go into more detail about that. Unfortunetely, when they don't get reimbursed due to pressure ulcers and the like is when they will have to start to address this, and it needs to come from top.
    I agree with this totally. I was a cna for 3 years and now a new lpn. And although your pts are refusing like previously stated they do not know what they are refusing although this can be construed as battery what is going on at your facility appears to be neglect There is no reason refusal or not to leave a pt sit in soiled briefs/bed EVER. Period. So u get more staff to help hange/turn them ect in case they become violent u are not commuting battery unless u are physically hurting them. I know it's a fine line but it seems as tho u will be more likely to lose your license (if the situation arose) for neglect opposed to battery. . And there is no reason a pt should get ulcers. They absolutely need to be cared for that is neglect I would be talking with don and management ASAP about these issues
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    It's situations like this that make me soooooo glad that my organization has established very strong Ethics Case Consultation committees in every one of our facilities. Members consist of clinical & non-clinical including at least one 'public' member - groups are facilitated by a chaplain or similarly qualified person. I have learned so much from these folks. Including the fact that just because someone is not 'competent' to exercise judgment about choice of chemotherapy vs. radiation, they certainly still have the capability of deciding if they want to be kept alive by artificial means - based on consideration of their life choices they have made over time to family members. I love our Ethics folks! Very committed to patient advocacy whenever legally possible.
    elkpark likes this.


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