Against Medical Advice

Book excerpt: Refusal, delay, or limitation of medical treatments, including vaccines, is an increasing phenomenon facing nurses and other healthcare practitioners daily. When a patient or family refuses treatment—maybe even lifesaving treatment—because it is contrary to their social, religious, or cultural beliefs, it can plunge healthcare providers, families, and patients into a difficult, emotionally charged conversation. Complex and diverse ethical dilemmas such as this can profoundly impact the health, welfare, and mental and emotional well-being of everyone involved. What’s more, today’s nurses and healthcare professionals will almost inevitably face this situation or one like it. Against Medical Advice details many of the medical, legal, social, cultural, and religious factors associated with treatment refusals. Authors Luanne Linnard-Palmer and Ellen Christiansen prepare healthcare professionals to compassionately assess and understand people’s beliefs, cultures, and philosophical perspectives. Their proven strategies and step-by-step examples guide providers to consider the patient’s and family’s point of view, share concerns with other healthcare team members, and negotiate the best possible outcome for all involved. TABLE OF CONTENTS Chapter 1: When Medical Treatment and Patient Needs Clash Chapter 2: Overview and Reasons for Treatment Refusals Chapter 3: Childhood Vaccines, Hesitancy, and Refusals Chapter 4: Pediatric Healthcare, Ethics, and Children’s Rights Chapter 5: Legal Implications and Consent: Informed Consent, Assent, and Parental Permission Chapter 6: Legal Perspectives of Treatment Refusal: Refusal Defined Chapter 7: In the Name of Religion: Historical Influences to Legal Exemptions Chapter 8: Adult Medical Treatment Refusals, Limitations, and Delays Chapter 9: Overview of Religious Doctrines Chapter 10: The Importance of Cultural Competence Chapter 11: Professional Groups’ Reactions to Treatment Refusal: Nursing, Medicine, Researchers, and Journalists Chapter 12: Overview of Professional Interventions: Power Distance, Negotiation, and Safety Appendix A: Reasons for Parental Decisions to Refuse Medical Treatment Appendix B: Guidelines for Staff Facing Parental Refusal of Pediatric Vaccines or Medical Treatments Appendix C: Guidelines for Staff Facing Adult Refusal of Medical Treatments Appendix D: Loss of Parental Guardianship: Court Overriding of a Parent’s Right to Refuse Medical Treatment Appendix E: Common Concerns About Vaccine Administration Appendix F: Pandemics and Trust in Rapid Vaccine Creation, Distribution, and Mandates Appendix G: Best Interest and the Law: Should State Statutes on Child Abuse Be Modified? Appendix H: Spiritual Abuse Defined Appendix I: Resources for More Information AVAILABLE ON THE SIGMA REPOSITORY · Chapter 2: Overview and Reasons for Treatment Refusals · AMA Quick Facts ABOUT THE AUTHORS Luanne Linnard-Palmer, EdD, RN, CPN, is a Professor of Nursing at Dominican University of California in San Rafael, California, and a Pediatric Educational Consultant and Pediatric Clinical Nurse at Sutter Health’s California Pacific Medical Center in San Francisco. Ellen Christiansen, DNP, RN, FNP-BC, PHNA-BC, is an Associate Professor of Nursing at Dominican University of California, where she teaches Community and Public Health Nursing.