Refusing Unwanted Treatments

All competent patients have the right to refuse unwanted treatments. This includes elderly patients who are hospitalized or reside in long-term care institutions. Since 1991, the federal Patient Self-Determination Act (PSDA) has been in effect. This law mandates that all patients in health care institutions receiving federal funds must be informed of their rights to complete advance directives. The law was formulated because of a growing recognition that patients' rights of self-determination, especially in end-of-life or catastrophic care situations, were not being respected (Marshall, 1995; Ulrich, 2001). In spite of the PSDA, problems persist concerning respect for patients' refusals of treatment. One reason for this is that not all important treatment decisions are associated with end-of-life or catastrophic care. Some treatment decisions concern medications, diet, and alternative treatments that might appeal to patients with specific values. Nurses have responsibilities to understand their patients' wishes regarding treatment and to assist them in articulating these preferences to other members of the health care team. Additionally, it is part of the nurse's advocacy role to ensure that the patient has the information needed to make such decisions.

Advance directives provide information about what the patient is willing to accept in terms of life-prolonging measures. This information can then be used in the event that the patient becomes unable to communicate his or her wishes. Further information on advanced directives may be found at a joint American Medical Association/American Association of Retired Persons Web site. State specific information can be accessed via the Legal Counsel for The Elderly on the resources page.