title: The cost of refusing treatment and equality of outcome.
abstract: Patients have a right to refuse medical treatment. But what should happen after a patient has refused recommended treatment? In many cases, patients receive alternative forms of treatment. These forms of care may be less cost-effective. Does respect for autonomy extend to providing these alternatives? How for does justice constrain autonomy? I begin by providing three arguments that such alternatives should not be offered to those who refuse treatment. I argue that the best argument which refusers can appeal to is based on the egalitarian principle of equality of outcome. However, this principle does not ultimately support a right to less cost-effective alternatives. I focus on Jehovah's Witnesses refusing blood and requesting alternative treatments. However, the point applies to many patients who refuse cost-effective medical care.
authors.affiliation: Monash University, Clayton, Victoria, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Savulescu
mesh_terms: D001315:Australia; D001803:Blood Transfusion / Q000191:economics; D002835:Christianity; D000529:Complementary Therapies; D003362:Cost-Benefit Analysis; D004921:Erythropoietin / Q000191:economics; D028663:Ethical Theory; D004992:Ethics, Medical; D017048:Health Care Costs / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D006801:Humans; D033221:Jehovah's Witnesses; D010344:Patient Advocacy / Q000331:legislation & jurisprudence; D018579:Patient Selection; D026684:Personal Autonomy; D040841:Resource Allocation; D012935:Social Justice; D012945:Social Values; D016896:Treatment Outcome; D016312:Treatment Refusal / Q000331:legislation & jurisprudence
chemical_list: D004921:Erythropoietin