[Refusing treatment: patient responsibility and autonomy. About a French National Consultative Ethics Committee statement(no 87, April 2005)]

Abstract

A recent French National Consultative Ethics Committee statement confirms that medical doctors are required by law to accept a patient's refusal of treatment, even if the consequence is the loss of chances of being cured. This refusal raises difficult clinical and ethical issues. Respecting a patient's decision is only valid when he/she is fully responsible, able to understand the proposed treatments and the consequences of his/her refusal, uninfluenced by friends and relatives, ignorance, disarray, an excessively pessimistic appraisal of the situation, a conflict with the doctors or with medicine. Doctors must avoid passively accepting a refusal without discussion but must also avoid paternalism or moral pressure. Adequate mutual knowledge of the way they think, their values and their objectives helps to maintain mutual respect and confidence in the patient-doctor relationship: the doctor is not a "supertechnician" nor is the patient a treatment consumer. Information, knowledge of the possibilities and limits of current medicine and of patients'complex, conscious and unconscious motives (which justifies the psycho-oncologist's role), recommendations of medical societies, experience of difficult ethical issues help to avoid unauthentic refusals, conflicts and staff burnout.