Irrational refusal of medical treatment: ethical considerations

This paper examines the ethical issues surrounding a specific case of patient refusal of medical treatment: refusal stemming from irrational beliefs or misinformation. While respecting patient autonomy is a foundational principle of contemporary medical ethics, its application becomes challenging when patients reject life-saving treatments based on irrational beliefs (e.g., conspiracy theories, as seen during the COVID-19 pandemic). This situation creates a paradox: the doctrine of informed consent and dissent, while designed to protect conscious and autonomous choices, can also enable misinformed, irrational decisions. Upon distinguishing three kinds of treatment refusal (rational, non-rational, and irrational), the paper clarifies why the moral distress experienced by healthcare professionals when dealing with irrational refusals is justified and reflects a proper moral disposition. It argues that immediate acceptance of such refusals reflects a shallow understanding of both patient autonomy and the doctor-patient relationship. Furthermore, the paper advocates for a deliberative model, wherein physicians are morally obliged to engage patients in thoughtful dialogue and attempt to persuade them - within available time constraints. Attempts to persuade patients are not forms of disguised paternalism, nor are they primarily inspired by the principle of beneficence. On the contrary, such attempts derive from a proper understanding of autonomy: physicians respect their patients as moral agents by engaging them in frank exchanges, thus creating the conditions for more authentic autonomous choices.