What are your feelings about requests to withhold treatment in a young person with a newly acquired disability?

Right to Refuse Treatment

Situation

R.D., a 25-yr-old man, had a SCI to C7-8 after a motorcycle accident.

He was diagnosed with anterior cord syndrome and has motor

paralysis, which may prevent him from riding motorcycles again. He

has become extremely depressed and no longer wishes to live.

Because of his emotional state, R.D. is now refusing to eat. Can he be

forced to receive EN?

Ethical/Legal Points for Consideration

• Withholding treatment in a newly injured but otherwise healthy

young adult may present an ethical dilemma for some nurses.

They may consider it assisted suicide and believe that it violates

the ethical principles of beneficence and nonmaleficence.

• A competent adult has the right to consent to or refuse medical

treatment under the right to privacy, the Fourteenth Amendment

of the Constitution, and case law.

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• Case law has supported the concept that forced treatment is

battery (unlawful use of force on somebody). A mentally

competent, physically incapacitated adult can refuse EN. The

health agency must follow the patient’s wishes.

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• To be competent to take part in informed consent or refusal, an

adult must be able to understand the information provided about

the procedure or treatment, consider choices among available

alternatives, and make a choice based on his values and

preferences. Depression may not be a factor in determining

competency to make informed treatment choices.

• If, after adequate evaluation and treatment for pain, depression,

or other medical conditions, the patient persists in his refusal, his

wishes must be respected.

• Refusal to eat or drink has never been upheld as illegal, and the

alternative—forced eating and drinking—is clearly a violation of

patient rights and the criminal act of battery.

Discussion Questions

1. What are your feelings about requests to withhold treatment in

a young person with a newly acquired disability?

2. What resources are available to help R.D., his family, and

nursing staff deal with this emotionally charged and ethically

complex situation?