The right to refuse treatment--an ethical case study

Every day throughout the UK medical professionals working within Intensive Therapy Units (ITUs) are faced with the ethical dilemma of whether it is right to withhold extraordinary treatments from patients. Within this case study an ethical dilemma arises from the question: 'Is it morally sound to treat this patient who, we knew, would have refused our care had he been able to give a written legally binding request not to receive extraordinary medical therapy?' This paper concentrates on the ethical decision-making process and seeking to find a solution to an everyday dilemma within moral philosophy. Personal and professional values and the prima facie principle of non-maleficence within which the doctrine of ordinary and extraordinary means, the doctrine of double effect and the slippery slope argument are discussed in their context relevant to an ITU situation. The nurse's role as patient advocate is addressed as the case study highlights the difficulties encountered in fulfilling this responsibility. It is hoped that the issues raised will help in clarifying how a real ethical dilemma for all the ITU team can be addressed and so help others faced with similar dilemmas. The decision-makers within this dilemma were the patient, family, and the ITU multidisciplinary team. The term extraordinary treatment is understood within biomedical ethics to encompass all medicines, therapies, and operations, which cannot be obtained or used without excessive expense, pain or other physical inconvenience, or which, if used, would not offer a reasonable hope of benefit.