title: Refusal of treatment, leading to death: towards optimization of informed consent.
abstract: Few medical decisions create more anguish than ones involving cessation of treatment, resulting in the death of a patient. In this article, the ethical and legal aspects of the withdrawal of treatment are examined with respect to a case of a 67-year-old man who fell and sustained a fracture of his second cervical vertebra, rendering him paralysed and respirator-dependent. He immediately requested the withdrawal of treatment, but his family baulked. Ethics consultation recommended delaying the decision, to give the patient enough time to foster optimal comprehension and synthesis of information related to his condition and the consequences; we refer to this process as "optimization of informed consent." When the patient was informed of the delay and the reasons for it, he was assured (and subsequently repeatedly reassured) of his ultimate right to refuse treatment at a future date. On balance, optimization of informed consent promotes patients' autonomy, even though it involves suspending this autonomy for a time. It is also consistent with physicians' responsibility to promote life and avoid premature death.
authors.affiliation: Faculty of Administration, University of Ottawa, 1880 Lorraine Ave., Ottawa ON K1H 6Z9, Canada.
authors.forename: B
authors.initials: B
authors.lastname: Trevor-Deutsch
authors.forename: R F
authors.initials: RF
authors.lastname: Nelson
mesh_terms: D000368:Aged; D003657:Decision Making; D033061:Ethics Consultation; D005190:Family; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence; D008297:Male; D016743:Mental Competency; D010243:Paralysis / Q000523:psychology; D026706:Paternalism; D010348:Patient Care Team; D026684:Personal Autonomy; D011788:Quality of Life; D012297:Right to Die; D013119:Spinal Cord Injuries / Q000523:psychology; D013997:Time Factors; D016312:Treatment Refusal / Q000331:legislation & jurisprudence / Q000523:psychology*; D028761:Withholding Treatment