Navigating Care Refusal and Noncompliance in Patients with Opioid Use Disorder. J Emerg Med 2024 Aug;67(2):e233-e242
Date
06/08/2024Pubmed ID
38849254DOI
10.1016/j.jemermed.2024.03.008Scopus ID
2-s2.0-85195294675 (requires institutional sign-in at Scopus site) 2 CitationsAbstract
BACKGROUND: For many emergency physicians (EPs), deciding whether or not to allow a patient suffering the ill effects of opioid use to refuse care is the most frequent and fraught situation in which they encounter issues of decision-making capacity, informed refusal, and autonomy. Despite the frequency of this issue and the well-known impacts of opioid use disorder on decision-making, the medical ethics community has offered little targeted analysis or guidance regarding these situations.
DISCUSSION: As a result, EPs demonstrate significant variability in how they evaluate and respond to them, with highly divergent understandings and application of concepts such as decision-making capacity, informed consent, autonomy, legal repercussions, and strategies to resolve the clinical dilemma. In this paper, we seek to provide more clarity to this issue for the EPs.
CONCLUSIONS: Successfully navigating this issue requires that EPs understand the specific effects that opioid use disorder has on decision-making, and how that in turn bears on the ethical concepts of autonomy, capacity, and informed refusal. Understanding these concepts can lead to helpful strategies to resolve these commonly-encountered dilemmas.
Author List
Marshall KD, Derse AR, Weiner SG, Joseph JWAuthor
Arthur R. Derse JD, MD Director, Professor in the Institute for Health and Humanity department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Analgesics, OpioidDecision Making
Humans
Informed Consent
Opioid-Related Disorders
Patient Compliance
Personal Autonomy
Treatment Refusal
