When Does ‘No’ Mean ‘No’ In Health Decisions

Post Written By Guest Blogger, Kathy Kastner

That’s what seems to happen if someone – anyone – decides they don’t want any more medical interventions. Take this story of a 70-year old woman – still vigorous and enjoying life:

“After her oncologist carefully explained the benefits, risks, and alternatives to the recommended course, she declined to proceed further.  Instead of launching into an arduous medical regimen, she has chosen to focus the remainder of her time and attention elsewhere, on matters outside of medicine.”

This did not sit well in the medical field:

“On hearing such a story, some of my medical colleagues question the patient’s soundness of mind.  Could she be depressed?  Might she be in the early stages of dementia?  Could she have simply failed to grasp the full gravity of her situation?  To them, the failure to take advantage of the wonders of modern medicine smacks of irrationality.  The solution?  Her physicians need to sit her down again and explain the situation more clearly.  Should this fail to elicit her consent, perhaps a psychiatry consult would be in order.”

Why on earth can’t the uber zealous healthcare professionals just take it at face value?

As she sees it, she is not refusing treatment.  She is affirming life.

“….she envisions her last months as the final, fitting chapter of a life well lived – her chance to live up to all she has been pursuing since her youth.  As she sees it, she is not refusing treatment.  She is affirming life.  She knows that its end is every bit as natural as its beginning.  Her goal is not to live forever, but to live each day to the fullest and, when her time finally comes, to take her leave of it as gracefully as she can.”

Excerpted from The Health Care Blog  : Informed Refusal by Richard Gunderman, MD PhD

It’s not just cancer patients (where much of the focus seems to be) Annie Brewster – herself a doctor – opted not to take doctor-recommended medication for her Multiple Sclerosis.

“I am deliberately choosing to ignore my doctors advice. He wants me to be on medication, but I quit a month ago. While I trust that I am doing the right thing, I can’t help but feel that I am a “bad” patient, a disappointment.”

She can look at it from both sides:

“We (doctors) prefer to do something instead of nothing, and this often means prescribing medications. For the most part, patients encourage this behavior.”

Certainly, we patients want to get ‘fixed’. But when it’s un-fixable, what’s wrong with our healthcare professionals supporting us – and (dare I say) – suggest a Palliative Care consult so’s we can feel as good as possible – no matter how long or short a time we have to live.