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Right to refuse treatment
Cathy Rose

HR 107
Loretta horton
11/6/14
HR 107
Loretta horton
11/6/14
Hutchinson Community College
Hutchinson Community College

Freedom. It is one of the most powerful words in the world and the basis of our United States Constitution. Americans have more freedoms than any other country in the world. But is freedom an absolute? To have absolute freedom would mean to have no laws put upon society. No laws against stealing, killing, or doing other harm to others. I doubt anyone would disagree that we need laws which inhibit our freedoms in order to protect society against harmful acts by others. But what about our individual freedoms such as to smoke or wear seatbelts? It’s harmful to us and others through second hand smoke yet we have the freedom or right to smoke or not smoke. We can be fined for not wearing one yet it does not harm others if we don’t. This law is in place to protect us in case of an accident. Our government has opted for laws which protect us from making decisions that could result in harm to our persons if not followed and left some of our freedoms intact even though they are known to be harmful to us. One such freedom or “right” they have left in our hands is the “Right to Refuse Medical Treatment”. The US Supreme Court has determined that we, as individuals, have a constitutional right to determine our fate when it comes to what medical treatments we want and don’t want (1). However, this is not an absolute or unlimited right. There are many factors that come into play for you to be able to make this decision such as competency, legal status, and religious beliefs. There are many other factors that also can determine your right to refuse treatment but this paper will examine the issues of competency, legal status, religious beliefs, and what it means to make an informed decision. Before a person can refuse the treatment they must be informed of what the treatment is and what the expected outcome will be and risks of having the treatment. The physician providing treatment is responsible for providing this information to the patient. Once you have the information you can accept or refuse the treatment if you are of legal status and competent. Legal status means you are of legal age, which may vary from state to state, or be an emancipated minor. An emancipated minor is one that is legally responsible for themselves and their children. For example, a 15 year girl with a child is considered an emancipated minor. If you are of legal status then you still have to be deemed competent. To be competent you must be mentally able to understand what you are being told and the consequences of actions to be taken or not taken. Sometimes the courts have to make the determination of competency such as for the mentally handicapped. There are also issues that can arise that would make a normally competent person incompetent to make this type of decision. An example would be someone in the emergency room that is under extreme pain or maybe unconscious. The courts have determined that extreme pain can alter a person’s ability to make good decisions and thus gives the emergency room physician the right to treat them against their will. Let’s look at three scenarios to better understand these issues.
The first scenario is a woman of 35 who goes to her primary physician for stomach problems. After several tests, her physician tells her she has stage 4 stomach cancer and should start chemotherapy followed by radiation as soon as possible. After the initial shock wears off the patient asks her doctor about other options and life expectancy with this type of cancer. Her physician tells her that the success rate of survival for this type of cancer with and without treatment. He also informs her that there are no alternatives to the chemotherapy and radiation as surgical removal is not an option. The patient still wants more information so her doctor schedules an appointment with an oncologist. The oncologist confirms the information that the attending physician has told the patient. The oncologist also tells her that the chemotherapy and radiation would at best extend her life by 1 year on average if it worked and shrunk the tumor. He tells her that each patient’s outcome is different and cannot be predicted. The patient makes a decision based on this information not to have the treatment and would rather live out the rest of her life as best she can. This is an informed decision. But does she have the right to refuse the treatment? She is of legal age, she has asked questions and been informed of what will happen if she does not take the treatment. She understands that she will die without it but also understands that the likelihood of survival with treatment is minimal. She would be considered competent to make this decision even though it means she will die sooner than later.
The second scenario is a man who is brought into the emergency along with his wife. They have just been in a car accident. His wife is unconscious and in critical condition. The husband has a foot that has been crushed in the accident and should be removed immediately. The man is in severe pain and in distress over his wife. He will not give consent to any treatment or the removal of his foot. Instead he is continually asking about his wife who has been taken into surgery. The emergency room doctor trying to treat him informs him of what will happen if he does not allow them to treat him including the removal of his foot. He again dismisses the doctor and refuses asking about his wife again. After a few more moments, the man goes unconscious due to blood loss. The doctor makes the determination that the man is incompetent to refuse treatment due to pain and distress. The physician notes this in the medical record and proceeds by stabilizing him and then sending the man into surgery to remove his foot and save his life. The emergency room physician has right to make this decision.
Now let’s look at one more scenario and perhaps the most difficult. This one is a boy of 12 who needs a liver transplant. His parents refuse stating their religion does not allow this type of treatment or their souls cannot go to heaven. The doctor informs the parents that the child will die without the transplant. The parents still refuse as does the child. The doctor confers with the hospitals legal staff for what can be done to save this child’s life. The doctor is told that they do have the option to contact child protective services to have the child taken from the parents for neglect or child endangerment. The doctor is hesitant to do this as the parents, other than this issue, are very good parents and love their son. The legal staff makes the decision to call child protective services who in turn removes the child temporarily from the home. The child’s fate is now in the hands of the court system to determine if the parents have the right to decline their child a transplant. This decision can be appealed by both the parents and child protective services causing a delay in treatment which could result in the child’s death before the courts come to a final ruling. Should parents have this right to let their child die? Should the fact that the child says no to the transplant, understanding he will die have any part in the decision? As Americans we have the freedom of religion but to what extent should that right allow someone to die?
American ethics are ever changing. Each generation brings more change and this change tends to push for individual freedoms including the right to die. No one knows what our society will desire in the future but the right to refuse treatment will continue to be debated for many years to come.

References: 1. Cruzan v. Director, Missouri Department of Health, 110 S. Ct 2841, 111 l. Ed. 2d 224 (1190).
Bibliographies:
1. John F. Kennedy Online database:
MedlinePlus www.nlm,nih.gov/medlineplus/medicalethics.html 2. The Sullivan Group www.thesullivangroup.com 3. AAOS www.aaos.org 4. American Cancer Society www.cancer.org