Revive and Refuse: Capacity, Autonomy, and Refusal of Care After Opioid Overdose. Am J Bioeth 2024 May;24(5):11-24
Date
05/23/2023Pubmed ID
37220012DOI
10.1080/15265161.2023.2209534Scopus ID
2-s2.0-85160037435 (requires institutional sign-in at Scopus site) 15 CitationsAbstract
Physicians generally recommend that patients resuscitated with naloxone after opioid overdose stay in the emergency department for a period of observation in order to prevent harm from delayed sequelae of opioid toxicity. Patients frequently refuse this period of observation despiteenefit to risk. Healthcare providers are thus confronted with the challenge of how best to protect the patient's interests while also respecting autonomy, including assessing whether the patient is making an autonomous choice to refuse care. Previous studies have shown that physicians have widely divergent approaches to navigating these conflicts. This paper reviews what is known about the effects of opioid use disorder on decision-making, and argues that some subset of these refusals are non-autonomous choices, even when patients appear to have decision making capacity. This conclusion has several implications for how physicians assess and respond to patients refusing medical recommendations after naloxone resuscitation.
Author List
Marshall KD, Derse AR, Weiner SG, Joseph JWAuthor
Arthur R. Derse MD, JD Director, Professor in the Institute for Health and Equity department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Analgesics, OpioidHumans
Naloxone
Opioid-Related Disorders
Treatment Refusal
