Treatment Refusals: Autonomy, Paternalism, and the “Best Interest” of the Patient

  • Ruth Macklin


Closely related to the problems of competency and consent discussed in the preceding chapter is the question of how to handle treatment refusals by patients. It was noted there that an asymmetry exists between the need physicians perceive to assess a patient’s competency to grant consent in the first place and the retrospective assessment of competency once a patient has refused treatment. Put another way, questions of competency usually do not arise when a patient willingly goes along with whatever treatment the physician recommends. It is well known that treatment refusals are often construed as evidence that the patient is incompetent to grant or refuse consent, but that view of the matter is surely mistaken. However competency is to be assessed, it cannot simply be explicated in terms of agreement with what a physician recommends. Even if a patient’s refusal appears irrational, on the face of it, that is still not grounds for assuming that the person is incompetent to choose or refuse a recommended treatment. It is worth recalling that presumptions of incompetency are often made when there is no other evidence of impairment—the patient is not a psychiatric patient, or suffering from senile dementia, or afflicted with a condition that normally impairs cognitive processes.


Psychiatric Patient Free Action Mental Patient Life Plan Individual Liberty 
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  1. Cassell, E. J. (1978). What is the function of medicine? In: Death and Decision (McMullin, E., ed.), pp. 35–44. Westview Press, for AAAS, Boulder, Colorado.Google Scholar
  2. Culver, C. M., and Gert, B. (1982). Philosophy in Medicine. Oxford University Press, New York.Google Scholar
  3. Dworkin, G. (1976). Autonomy and behavior control. Hastings Center Rep. 6, 23–28.CrossRefGoogle Scholar
  4. Miller, B. L. (1981). Autonomy and the refusal of lifesaving treatment. Hastings Center Rep. 11, 22–28.CrossRefGoogle Scholar
  5. Roth, L. B., Meisel, A., and Lidz, C. W. (1977). Tests of competency to consent to treatment. Am. J. Psychiat. 134, 279–284.PubMedGoogle Scholar
  6. Shwed, H. (1980). Social policy and the rights of the mentally ill: Time for the re-examination. J. Health Politics Policy Law 5, 193–198.Google Scholar
  7. Szasz, T. S. (1977). Psychiatric Slavery: When Confinement and Coercion Masquerade as Cure. The Free Press, New York.Google Scholar
  8. Szasz, T. S. (1961). The Myth of Mental Illness. Hoeber-Harper, New York.Google Scholar
  9. Szasz, T. S. (1982). The right to refuse treatment: A critique. In: Who Decides? (Bell, N. K., ed.). Humana Press, Clifton, N.J.Google Scholar
  10. Tancredi, L. R. (1980). The rights of mental patients: Weighing the interests. J. Health Politics Policy Law 5, 199–204.Google Scholar

Copyright information

© Springer-Verlag New York Inc. 1983

Authors and Affiliations

  • Ruth Macklin
    • 1
  1. 1.Department of Community HealthAlbert Einstein College of MedicineBronxUSA

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