CLINICAL ETHICS

Physicians’ evaluations of patients’ decisions to refuse oncological treatment

T van Kleffens and E van Leeuwen

Department of Philosophy and Medical Ethics, VU University Medical Center, Amsterdam, the Netherlands

Correspondence to:
Correspondence to:
T van Kleffens
VU University Medical Center, Department of Philosophy and Medical Ethics, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands; t.vankleffens{at}vumc.nl

Objective: To gain insight into the standards of rationality that physicians use when evaluating patients’ treatment refusals.

Design of the study: Qualitative design with indepth interviews.

Participants: The study sample included 30 patients with cancer and 16 physicians (oncologists and general practitioners). All patients had refused a recommended oncological treatment.

Results: Patients base their treatment refusals mainly on personal values and/or experience. Physicians mainly emphasise the medical perspective when evaluating patients’ treatment refusals. From a medical perspective, a patient’s treatment refusal based on personal values and experience is generally evaluated as irrational and difficult to accept, especially when it concerns a curative treatment. Physicians have a different attitude towards non-curative treatments and have less difficulty accepting a patient’s refusal of these treatments. Thus, an important factor in the physician’s evaluation of a treatment refusal is whether the treatment refused is curative or non-curative.

Conclusion: Physicians mainly use goal oriented and patients mainly value oriented rationality, but in the case of non-curative treatment refusal, physicians give more emphasis to value oriented rationality. A consensus between the value oriented approaches of patient and physician may then emerge, leading to the patient’s decision being understood and accepted by the physician. The physician’s acceptance is crucial to his or her attitude towards the patient. It contributes to the patient’s feeling free to decide, and being understood and respected, and thus to a better physician–patient relationship.

Keywords: rationality; treatment refusal; medical decision making; clinical oncology

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