In today’s Think Piece, consider the case of a patient refusing recommended spine surgery. The competent patient was fully cognizant of the risks, benefits and alternatives to the surgery. He was specifically advised that any delay could result in permanent neurologic injury, including loss of bowel and bladder function. Despite this information, the patient steadfastly refused to give consent and the surgeon was unable to intervene as recommended. As expected, the patient subsequently developed permanent disability, further complications and died. The family sued the physician for not performing the necessary spinal surgery.As a corollary to the doctrine of informed consent, a patient has a right to refuse recommended treatment. The AMA and other organizations confirm that all incidents of informed refusal must be well-documented in the patient’s medical records. Under certain circumstances, it is prudent to have the patient sign an AMA-type document confirming the discussion.
Bottom Line: Avoid the “I said, she said” battle. Document discussions, particularly the informed refusal, after the material risks, benefits and alternatives have been provided.
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