Italy to Allow Living Wills and the Refusal of End-of-Life Care

NYT, 14 December 2017
Author: Elisabetta Povoledo
“Italian lawmakers passed a law on Thursday allowing adults to decide, in concordance with their doctors, their end-of-life medical care, including the terms under which they can refuse treatment. The law permits Italians to write living wills and refuse medical treatment, artificial nutrition and hydration.”
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Nonvoluntary Psychiatric Treatment Is Distinct From Involuntary Psychiatric Treatment

JAMA. 2017; 318(11): 999-1000.
Author: Dominic A. Sisti
“Some of the most ethically challenging cases in mental health care involve providing treatment to individuals who refuse that treatment. Sometimes when persons with mental illness become unsafe to themselves or others, they must be taken, despite their outward and often vigorous refusal, to an emergency department or psychiatric hospital to receive treatment, such as stabilizing psychotropic medication. On occasion, to provide medical care over objection, a patient must be physically restrained.”
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Cake or death? Ending confusions about asymmetries between consent and refusal

J Med Ethics 2016;42:748-754
Author: Rob Lawlor
“In this paper, I will argue that much of the debate concerning asymmetries between consent and refusal (eg, in a case in which an adolescent is granted a right to consent to treatment, but not a right to refuse treatment) is confused. My aim in this paper is to highlight nuances and ambiguities, and to emphasise the fact that we are not just addressing a puzzle about one asymmetry between consent and refusal.”
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Doctors Have no Right to Refuse Medical Assistance in Dying, Abortion or Contraception

Bioethics. doi:10.1111/bioe.12288
Authors: Savulescu, J. and Schuklenk, U.
“In an article in this journal, Christopher Cowley argues that we have ‘misunderstood the special nature of medicine, and have misunderstood the motivations of the conscientious objectors’. We have not. It is Cowley who has misunderstood the role of personal values in the profession of medicine. We argue that there should be better protections for patients from doctors’ personal values and there should be more severe restrictions on the right to conscientious objection, particularly in relation to assisted dying. We argue that eligible patients could be guaranteed access to medical services that are subject to conscientious objections by: (1) removing a right to conscientious objection; (2) selecting candidates into relevant medical specialities or general practice who do not have objections; (3) demonopolizing the provision of these services away from the medical profession.”
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Should we be forcing people with severe mental illness to have treatment they don’t want?

The Conversation, 31 August 2016
Author: Christopher Ryan
“If you understand what is involved and can weigh up the risks and benefits of your choice, you can refuse medical treatment even if you could die as a result. People competently refuse chemotherapy, renal dialysis or operations quite often. They may do so for any any number of reasons, such as not agreeing with their diagnosis or not liking the idea of medications. However, until very recently, it has been a different story for mental illness. Until 2013, laws in every Australian state and territory allowed forcing people to have psychiatric treatment if it was thought necessary to protect them from serious harm – even if they competently refused it.”
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Right to refuse treatment in Turkey: a diagnosis and a slightly less than modest proposal for reform

J Med Ethics doi:10.1136/medethics-2015-103266
Author: Nurbay Irmak
“This paper examines the current state of right to refuse medical treatment in Turkey. Even though there are only a few studies carried out with Turkish physicians on their attitude towards the right to refuse treatment, I argue that recent studies on physicians’ views on informed consent and honest disclosure show that Turkish physicians do not tend to recognise their patients’ right to decline treatment. This is because the refusal of treatment crucially requires that patients be properly informed and asked for their consent before the treatment. Turkish physicians and healthcare providers’ tendency to ignore the right to decline medical treatment cannot be separated from their paternalistic approach to patients and their rights.”
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Teen’s forced chemo may continue, Connecticut court rules

CNN, 9 January 2015
Author: Debra Goldsmith
“The Connecticut Supreme Court ruled Thursday that the state may continue to force a teenager to undergo chemotherapy treatments that could save her life.The court said that attorneys for the girl — who is 17 and therefore still a minor — failed to prove that she is mature enough to make her own medical decisions.”
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