“Just Say No”…But Can You?

We teach people to “Just say NO,” but can everyone? Consider the question from two viewpoints: patient and provider.

Can a patient say NO?
Can a patient say NO to care, even if that care that might save his or her life? Why would someone choose death? Some providers conclude that such a person is depressed or crazy. If the former, give Zoloft. If the latter, then the person is incompetent and decision-making authority can be taken away. A Dartmouth Center Study reports that many elderly patients may not want “everything possible” done for/to them. When they try to place limits on their care, they meet great resistance from the medical providers.

Terri Schiavo or Nataline Sarkisyan both made national headlines while in vegetative states. They were unable to say NO to a feeding tube or a liver transplant respectively. Their families spoke for them and emphatically said yes! Suppose the girls had left living wills stating that they did not want to be sustained on life support. There are numerous cases showing where the State sided with families against the expressed wishes of the patient.

There are medical circumstances where the patient cannot “just say NO.”

Can a health care provider just say NO?
Can a provider say NO to medical care that is desired by the patient?

If a pregnant woman – her circumstances aside – requests an abortion, must the doctor do it? Different hospitals have rules in either direction: requiring the doctor to do the procedure if medically appropriate, or prohibiting the doctor from performing the procedure though medically indicated. In either case, the doctor’s personal “right to refuse” is compromised.

Can a soldier say NO to an order that he or she thinks is immoral or illegal? The Nuremberg War Crimes Trials proved that – except on the battlefield in time of war – the soldier can (and should.) Does the same principle apply to a healthcare provider?

Are there any circumstances where a nurse can refuse to implement an attending doctor’s orders? How about a pharmacist who has religious objections to providing birth control or moral qualms about anti-HIV drugs? Can that person refuse to fill a legally written prescription? What if he or she is the only pharmacist in town?

The doctors caring for 17-year-old Nataline Sarkisyan thought that a liver transplant was inappropriate on both medical and moral grounds. They tried to say NO. The insurance company supported the doctors’ position and denied authorization. Result: the family called a press conference and sued both claiming that they could not “say NO” to all possible medical care.

Bottom line
There are circumstances where either patient or health care provider is forbidden to “just say NO.”

System MD

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1 comment so far ↓

#1 ramon on 07.28.14 at 3:12 am

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ñýíêñ çà èíôó….

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