Refusal of Potentially Lifesaving Treatment

[Mike A. Fungin RN]

question: what thoughts and/or feelings come up for you when a patient refuses lifesaving care? how do you handle it?

i recently read a story about a patient with an extremely low h & h who was refusing blood, and one of the replies was "unfortunately it's a patient's right to refuse treatment."

how is this unfortunate? i recognize that what the reply really meant is that the consequence of the refusal (i.e. death) was unfortunate, not the actual right to refuse treatment. but still, how is this unfortunate if that was the decision this patient made for herself?

i'm not trying to be a smart-aleck, so don't get me wrong. i wouldn't have refused care for myself if it had been me. it's just that i've heard many comments like this before and they always cause me to raise an eyebrow. why do some of us view refusal of potentially lifesaving treatment as "unfortunate", "sad", or "too bad"?

it's been my experience that so long as a patient is competent and informed, i haven't felt a burning need to question why she is refusing treatment (much less to try and persuade her to accept it).

i guess i have trouble understanding why some of us in healthcare view refusal of lifesaving treatment in a negative light. anyone care to weigh in?

[Tait, MSN, RN]

I think because, by nature, most of us are wired to save lives. We work so intensely on helping, that we have to take a moment, step back and examine a situation like this.

For me knee jerk reaction is to be saddened that someone wouldn't want care that could potentially extend their life. Especially if they are fairly stable.

It takes a bit more reflection on a situation to come to a more "right to refuse" response for most of us I feel.

Tait

[flightnurse2b, LPN]

i grab the "refusal of treatment" form, let them sign, and support their decision. i don't try to persuade them, i just make sure they are aware of the potential risks of not taking the treatment, and it's actually required on our refusal of tx forms that the patient writes this in their own words.

to me, it is sad. especially like tait said when they are fairly stable, sometimes otherwise healthy, sometimes young with young children. yes, it is so hard, because sometimes you know that this person could probably walk out of the hospital if they consent to treatment.... but you can't force anything on anyone who doesn't want it, that's their right.

i lost a patient that was 22 years old, who had a pregnant wife, because he refused blood transfusions. it broke my heart the day he coded and died.... he was doing what was right under his set of religious beliefs and there was nothing i could do for him.. except support him and his family emotionally.

[slideboard]

Not to switch the topic/or sound grim but how about all those patients that aren't able to express their wishes enough to change the care they receive. I am talking about those who have lived their lives in the 70 + y.o category who wouldnt really benefit from lifesaving treatment Such as the patient "we" all know stands no chance at a life outside a hospital whose family member continues to keep them a full code and yada yada.......whats your view points on that?

[Carolbknits]

I think many people don't have peace with dying (like those who say its too bad they are refusing treatment). My father is on daily IV and basically has no life other than being housebound and tied to an IV pole daily. I know he would not refuse it because he doesn't have peace in the Lord nor peace with dying. I told my husband I am a DNR and he looked at me like I was nuts! Although I have 3 kids, I don't want to be kept alive by heroic measures, nevermind being coded and having a shell of the person I once was. I firmly believe when it is our time, its our time, no matter what "heroics" are done.

love hugs and prayers

Carol

[flightnurse2b, LPN]

I think many people don't have peace with dying (like those who say its too bad they are refusing treatment). My father is on daily IV and basically has no life other than being housebound and tied to an IV pole daily. I know he would not refuse it because he doesn't have peace in the Lord nor peace with dying. I told my husband I am a DNR and he looked at me like I was nuts! Although I have 3 kids, I don't want to be kept alive by heroic measures, nevermind being coded and having a shell of the person I once was. I firmly believe when it is our time, its our time, no matter what "heroics" are done.

love hugs and prayers

Carol

i feel that i am at peace with dying, if i'm a vegetable or i'm terminal, throw me on the beach and let me go in peace... but it is just human nature, especially a nurse's nature, to want to save a life if it can be saved.

i think the refusal of treatment the OP is not referring to DNR status, i think that he is referring to people who are refusing things like blood tx, tPA, surgery, etc. things that could return the patient back to their quality of life if they accept.

OP... please clarify?

[Tait, MSN, RN]

i feel that i am at peace with dying, if i'm a vegetable or i'm terminal, throw me on the beach and let me go in peace... but it is just human nature, especially a nurse's nature, to want to save a life if it can be saved.

i think the refusal of treatment the OP is not referring to DNR status, i think that he is referring to people who are refusing things like blood tx, tPA, surgery, etc. things that could return the patient back to their quality of life if they accept.

OP... please clarify?

:yeahthat:

Yeah I am at peace with my patients dying, maybe more so than my "cling to everything" mother is comfortable with. However I am still saddened by patients who don't want life-saving care.

Tait

[Virgo_RN, BSN, RN]

I have cared for such a patient, and I'd say perhaps the reason for the "unfortunately" in a case like this is that a blood transfusion is such a simple treatment, especially for someone relatively young and healthy with no comorbidities. For someone such as this to refuse such a simple treatment and risk death does, indeed, seem unfortunate. Not to mention the fiscal aspects of such a decision. Someone with such a critically low hematocrit will take time to rebuild their blood supply, time in a hospital bed (with all the associated costs such as bedside nursing care, medications, physical therapy, MD rounding, etc.) that could be reduced significantly by accepting a blood transfusion.

[Mike A. Fungin RN]

i think the refusal of treatment the OP is not referring to DNR status, i think that he is referring to people who are refusing things like blood tx, tPA, surgery, etc. things that could return the patient back to their quality of life if they accept.

OP... please clarify?

You're completely right that I meant things like blood transfusions.

I've got a star of life tattoo with the inscription "Morte Certa, Hora Incerta" or "Death is certain, time is not." I get wanting to save lives, and I'm all about trying to give people more time on this earth. At the end of the day though it's my patient's body, beliefs, decision, life, and death... not mine. I'm not going to take it home with me or lose any sleep over it if someone kicks it because they refused blood.

I dunno... maybe the reason that comes so easily to me is because of my experiences working inner-city EMS? I know I saw both more death and also much worse death in 7 years of that than I could in a lifetime of nursing.