There was an interesting thread on The National Review Online written by Wesley Smith, “Should Patients Be Allowed To Die From Bed Sore?” which discusses the ethical considerations involved when a patient effectively refuses medical care. Taking the concept of ‘refusing’ medical care one step further, Smith raises a point which I found to be particularly interesting as a nursing home abuse attorney, can patients in hospitals and nursing homes effectively refused to be ‘turned’ (‘turning’ allows the bodies natural circulatory process to take place and reduce the chance of a patient developing a wound) in order to prevent the development of bed sores or pressure sores?
Referencing a Medscape article written by bio-ethicist Art Caplan, “You MUST Let My bedsores Kill Me. You MUST!”, Caplan takes the position that all people should be entitled to make their own decisions when it comes to their medical care and personal needs. While discussing a situation in which a patient developed a bed sore during an admission to a medical facility, Caplan asserts that essentially each patient should be entitled to refuse basic care such as turning so long as the patients decision doesn’t negatively impact those around him.
At the end of the day, I think this man did have the right to say “don’t touch me.” I think he had the right to say “don’t turn me.” But if his decision started to affect nursing and staff morale and began to become a problem in the delivery of care for others, then I believe that is a factor that has to be considered when deciding whether to honor what he says. The nurses cannot work if the unit becomes a smelly, untenable mess, and although this man had his rights, other people have their rights too. If I thought the care of others was being compromised by these morale issues and staff problems, I might override a patient’s wishes. I might not honor his request in the name of other people’s rights. In my opinion, there may be limits to what you can request when it affects the care that others can receive. That is a trade off that has to be weighed at all times.