Ethical Issues involved when patients refuse treatment for life-threatening conditions

When a

patient

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requests

the

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apply

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discharge of a

patient

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, the medical

staff

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must

first

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check whether the

patient

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is capable of making decisions on his own. The

patient

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's decision-making

ability

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means the capacity to understand the

patient

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's condition and necessary treatment procedures after receiving sufficient information related to prescription from the medical team, compare the benefits and risks of each medication method, and make reasonable decisions according to the evaluation results. The following four basic factors can be used to objectively evaluate a

patient

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's decision-making

ability

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. (1) Can the

patient

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accurately convey his or her choice to the medical

staff

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? (2) Does the

patient

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fully understand his medical condition and treatment methods? (3) Does the

patient

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understand the benefits and risks of his or her choice? (4) Can the

patient

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properly explain the reason for his or her decision-making?If all four of the above questions fall under 'yes', the medical crew can determine that the

patient

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has decision-making

ability

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.

On the other hand

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,

judgment

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on a

patient

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's decision-making qualification should be made more strictly if there is a high risk of fatal consequences when discharged from the hospital. It was judged that the decision-making skill was not intact for emergency patients who refused remedies

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as gastric lavage by visiting the emergency room after drinking pesticides with the purpose of suicide. In

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case, the court evaluated that the

patient

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has no decision-making

ability

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due to medical conditions

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as drinking and pesticide addiction, and if there are any medical problems (addiction, pain, fever, withdrawal symptoms, etc.), immediate therapy should be performed. 1. In principle, it is necessary to respect the

patient

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's decision. The principle of respect for autonomy is one of the four principles of medical ethics, meaning the right of patients to decide and reject therapy or cure to be implemented on them. When grasping decision-making

ability

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, it is evaluated whether the

patient

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can explain the reason for decision-making, and at

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time, it is necessary to check whether external factors

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as economic factors are involved. The final responsibility for the decision-making of the

patient

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must be informed that the

patient

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himself or herself is responsible, and the medical

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is obligated to explain to the

patient

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in advance about possible medication methods, treatments, and possible risks. 2. According to the

Patient

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Care Act, if a

patient

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does not have the qualification to make a determination, it is required to explain the medical practice to the legal representative who will make the

patient

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's agreement and obtain consent. The criterion for

judgment

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when making a proxy doctor is to

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follow the compromise intention specified by the

patient

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in advance.

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is the case in which there is a record of the

patient

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's intention, or when a family member or close person is informed of the preferred treatment. The criterion for estimation

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is to make a decision based on the operation choice that the

patient

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has previously preferred, and care should be taken not to reflect the purpose of the medical

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or agent, and if there is an insufficient basis for estimation of the

patient

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's decision. It is stated that if the

patient

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himself or herself is in a state where it is difficult to express his or her aim, the medical personnel should respect the plan and

judgment

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of the

patient

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's representative,

such

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as his or her family, but try to appreciate and ensure the

patient

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's usual intentions and interests as much.