Refusal of treatment: an ethical dilemma

When a patient with a new spinal cord injury (SCI) refuses all care, the treatment team struggles with an ethical dilemma. The issues of patients' rights and autonomy are in conflict with the concepts of beneficence and nonmaleficence. Thomasma (1978) recommended a model useful in addressing situations in which values are in conflict. This model for an ethical workup is applied retrospectively to review a specific clinical case. The need to recognize and respect as many ethical principles as possible is identified as useful in reaching some acceptable resolution of an ethical dilemma.