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Article
September 9, 1983

Patients Who Refuse Treatment in Medical Hospitals

Author Affiliations

From the Department of Psychiatry (Drs Appelbaum and Roth), University of Pittsburgh School of Medicine, the University of Pittsburgh School of Law (Dr Appelbaum), and the Law and Psychiatry Program, Western Psychiatric Institute and Clinic (Drs Appelbaum and Roth), Pittsburgh.

JAMA. 1983;250(10):1296-1301. doi:10.1001/jama.1983.03340100030024
Abstract

Treatment refusal in medical hospitals, despite the interest it has aroused among lawyers and ethicists, has been largely ignored by the medical profession. This study of the phenomenon in a number of medical and surgical settings has disclosed that refusal is a common occurrence. In this study, refusals were often precipitated by problems within the physician-patient relationship, although several interactive factors were usually involved. Physicians' responses to refusal tended to be undifferentiated with regard to the precipitants, depending more heavily on the medical urgency of the situation. Costs of refusal were measurable in terms of delay and increased expense when treatment was ultimately accepted and, less commonly, in terms of physical harm to the patient. These findings illustrate important strains in the modern physician-patient relationship and suggest that closer attention to factors underlying refusal may increase the rate of successful resolution.

(JAMA 1983;250:1296-1301)

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