Treatment refusal in medical hospitals, despite the interest it has aroused among lawyers and ethicists, has been largely ignored by the medical profession. This study of the phenomenon in a number of medical and surgical settings has disclosed that refusal is a common occurrence. In this study, refusals were often precipitated by problems within the physician-patient relationship, although several interactive factors were usually involved. Physicians' responses to refusal tended to be undifferentiated with regard to the precipitants, depending more heavily on the medical urgency of the situation. Costs of refusal were measurable in terms of delay and increased expense when treatment was ultimately accepted and, less commonly, in terms of physical harm to the patient. These findings illustrate important strains in the modern physician-patient relationship and suggest that closer attention to factors underlying refusal may increase the rate of successful resolution.
KIE: The results of a study of treatment refusal in various medical and surgical settings within several Pittsburgh community and university hospitals are presented and analyzed. Refusal was found to be a common occurrence, usually involving multiple causative factors and precipitated by problems within the physician patient relationship. Physicians' responses to refusal were determined by their perception of the urgency of situations rather than by their communicating with patients. Most patients ultimately accepted treatment although the problems causing initial refusal were not always resolved.