A refusal to be treated

‘Business Dilemmas’

Sally Old

So how do you proceed when an older patient refuses treatment? Medico-legal adviser Dr Sally Old answers a reader’s query

Dilemma 1

Patient directive is troubling me

QI have an elderly patient with multiple co-morbidities who is often reluctant to engage with medical services and has, on occasion, stopped taking her medication.

Periodically, she has also stopped eating and drinking and refused admission to hospital, although she has resumed her medication and normal eating patterns within a few days. However, she drafted an advance decision to refuse treatment when she first stopped taking her medication.

I am concerned, as the patient has now developed diabetes and is once again refusing to take her medication.

Although I have not formally assessed her, I believe she does not lack capacity at present, although I am concerned that she will lose consciousness and therefore capacity.

If she does, her decision to refuse treatment may apply and I am concerned that I may be criticised if I do, or do not, treat the patient.

What should I do?

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