Path AETCOM patient refuse treatmemt .pptx

Patient refuse treatment

1. AETCOM Patient Refuse Treatment Group B : 63-75

2. 45 year old male Mr Umesh who is a known case of depression not taking his treatment regularly comes to the emergency with complaints of left sided chest pain. You do a ECG which shows features of ST elevation myocardial infarction. Cardiac enzymes and echo cardiography findings confirm your diagnosis. You decide the best choice of management is a primary angioplasty. You communicate the diagnosis and the treatment plan to the patient. The patient refuses to consider any medical interventions. You try to reason with him by explaining the complications of not treating including death and he tells you that he wishes to die and not take any treatment. His brother who is waiting by his bed takes you aside and tells you that the patient had attempted suicide a month back and was diagnosed with depression. He tells you that the patient is not competent to make the decision for himself and he as his brother would like to take the decision. He tells you that Mr Mahesh has a wife and a 5 year old son and his family are willing for the primary angioplasty. They ask you to make the necessary preparations for the procedure.

3. 1. Ethical Dilemma to Consider in This Patient Autonomy vs Beneficence: Balancing the patient's right to refuse treatment with the medical team's duty to provide life-saving care. Competency: Assessing whether Mr. Umesh is mentally competent to make decisions about his treatment given his history of depression and recent suicide attempt. Family Influence: Considering the role of the family in decision-making when the patient is unwilling to consent to treatment.

4. 2. Principles of Ethics Involved in This Case Autonomy: Respecting the patient's right to make informed decisions about his own health care. Beneficence: Acting in the best interest of the patient to save his life. Non-maleficence: Avoiding harm to the patient by ensuring he receives appropriate treatment. Justice: Ensuring fair and equitable treatment, considering both the patient’s wishes and the family's input.

5. 3. Collect and Analyse the Relevant Clinical Information Medical History: Depression, non-compliance with treatment, recent suicide attempt. Current Condition : Left-sided chest pain, ECG showing ST elevation myocardial infarction. Diagnostic Findings: Cardiac enzymes, echocardiography confirming the diagnosis.

6. 4. What are the Alternative Course of Action Second Opinion: Seeking input from another physician or a psychiatrist to evaluate the patient's mental competency. Psychiatric Intervention: Involving mental health professionals to address underlying depression and potential suicidal ideation. Risk-Benefit Discussion: Detailed discussion with the patient about the risks of refusing treatment and potential benefits of primary angioplasty.

7. 5. Suggest an Ethical Solution to Approach This Case Interdisciplinary Team Meeting: Including cardiologists, psychiatrists, and ethics committee to discuss the case. Advanced Directives: Reviewing any advanced directives or prior expressed wishes of the patient regarding such situations. Informed Consent: Ensuring the patient is fully informed about the implications of refusing treatment and confirming his competency to make such a decision.  

8. 6. Can the Clinician Treat the Patient with Family Members' Consent When Patient Himself Does Not Want Treatment? Legal Considerations: Depending on jurisdiction, if the patient is deemed incompetent, family members may have the legal authority to consent to treatment. Best Interest: If the patient is not competent, the clinician may consider the family’s consent in the best interest of the patient’s health. Ethics Committee: Involving the hospital’s ethics committee to mediate and provide guidance on proceeding with treatment against the patient's wishes.