title: Focus on patient management: responsibly managing psychiatric inpatient refusal of medical or surgical diagnostic work-up.
abstract: This column uses the tools of normative ethics-analysis and argument-to provide a reasoned account of and to identify ethically justified responses by the psychiatrist to psychiatric inpatients' refusal of medical or surgical diagnostic work-up. There are three relevant ethical considerations when psychiatric inpatients refuse medical or surgical diagnostic tests: balancing autonomy with beneficence, surrogate decision making and confidentiality, and managing strong feelings. Assisted decision making and assent are key management strategies for promoting patients' autonomy and for protecting against adverse consequences of decision making.
authors.affiliation: Center for Medical Ethics and Health Policy, Baylor College of Medicine, MS 420, Houston, TX 77007, USA. jsswinde@bcm.edu
authors.forename: J S
authors.initials: JS
authors.lastname: Swindell
authors.forename: John H
authors.initials: JH
authors.lastname: Coverdale
authors.forename: Holly
authors.initials: H
authors.lastname: Crisp-Han
authors.forename: Laurence B
authors.initials: LB
authors.lastname: McCullough
mesh_terms: D003219:Confidentiality; D003657:Decision Making; D003955:Diagnostic Tests, Routine / Q000523:psychology*; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D001523:Mental Disorders; D010346:Patient Care Management / Q000941:ethics*; D010817:Physician-Patient Relations / Q000941:ethics*; D019727:Proxy; D016312:Treatment Refusal