Management of refusal of medical treatment

As patients increasingly refuse medical and surgical treatment, the physician's response to this challenge to the healing-helping role is often extremely negative. Even though refusal may be felt by the patient as the only way to regain a measure of autonomy or control, such a response may have more to do with characteristic coping styles or interpersonal battles with the physician, staff, or family than with the treatment itself. Since management hinges on understanding the intrapersonal and interpersonal factors which contribute, it is essential to explore the meaning of the refusal. With reduction of the adversarial stance, the patient frequently regains enough sense of self to engage in a mutually cooperative effort. Even if the refusal stands, with understanding, the physician may be able to accept the patient's choice, and extrusion from the system upon which the patient is still dependent is avoided.