2.2.2 Patient Refusal of Information
Jonathan Breslin, PhD
- To appreciate how cultural variations in decision-making can impact the informed consent process
- To understand how to approach the informed consent process when a patient refuses to be informed
Mrs. Ostrowski is a 77-year-old widow who emigrated from an eastern European country a few years ago to live with her son and daughter-in-law, following the death of her husband. Although not completely fluent, she speaks enough English to communicate fairly easily. She had been experiencing several weeks of indigestion and reduced appetite, and after she began vomiting she agreed to let her son take her to the hospital. Diagnostic tests revealed a diagnosis of stage 2 gastric cancer with evidence of lymph node involvement. Her prognosis is guarded: there is a possibility of cure, but the standard treatment for her disease would involve total gastrectomy with adjuvant chemotherapy. Her physician finds Mrs. Ostrowski alone in her room and begins the process of delivering the diagnosis and discussing the treatment options. After the physician reveals the diagnosis, however, Mrs. Ostrowski politely stops her and says: "Doctor, I don't need to know all this. I'll do what you think is best."
- What are some of the reasons why someone like Mrs. Ostrowski might respond in this manner?
- Does the physician have to force the patient to listen to the information to fulfill the physician�s obligation to obtain informed consent for treatment?
- Should the physician just seek consent from Mrs. Ostrowski�s son instead?
- How should the physician proceed from here?
- Oliffe J, Thorne S, Hislop TG, Armstrong EA. Truth telling and cultural assumptions in an era of informed consent. Family & Community Health 2007; 30(1): 5�15.
- Freedman B. Offering truth: one ethical approach to the uninformed cancer patient. Archives of Internal Medicine 1993; 153(5): 572�6.
- Etchells E, Sharpe G, Burgess M, Singer PA. Bioethics for clinicians: 2. Disclosure. CMAJ: Canadian Medical Association Journal 1996; 155(4): 387–91.
- Etchells E, Sharpe G, Walsh P, Williams JR, Singer PA. Bioethics for clinicians: 1. Consent. CMAJ: Canadian Medical Association Journal 1996; 155(2): 177–80.
- Freedman B. A moral theory of informed consent. The Hastings Center Report 1975; 5(4): 32–9.