From the Guidelines
The patient's decision to refuse treatment against medical advice (AMA) should be respected, as they have the right to refuse treatment after being adequately informed of the risks, including potential death or injury, as stated in the ESPEN guideline on ethical aspects of artificial nutrition and hydration 1. The patient's complaint of a bone issue in the jaw area causing swallowing and breathing issues is concerning and could indicate several serious conditions, including infection, trauma, dislocation, or angioedema, which could potentially progress to airway compromise.
- The paramedic's explanation of the risks associated with refusing treatment is crucial in establishing that the patient was informed of the potential consequences of their decision.
- The patient's vital signs being within normal limits (WNL) and the physical assessment being unremarkable do not necessarily rule out the possibility of an underlying serious condition.
- The combination of symptoms such as jaw pain, swallowing, and breathing difficulties warrants further medical evaluation to determine the cause and appropriate treatment.
- The paramedic report should document the patient's decision to refuse treatment, the risks explained to the patient, and any warnings provided, which helps protect healthcare providers from liability while also creating a record of the patient encounter.
- It is essential to emphasize to the patient the importance of seeking medical evaluation as soon as possible, as symptoms could worsen rapidly, and delaying treatment could lead to severe consequences, including death or injury, as supported by the principle that a competent patient has the right to refuse treatment after adequate information, even when this refusal would lead to their death 1.
From the Research
Patient Refusal of Treatment
- The patient refused treatment against medical advice (AMA) and was informed of the risks of not seeking treatment for their condition 2.
- The patient's complaint of a bone issue in the jaw area causing swallowing and breathing issues is a serious condition that requires medical attention 3.
- All vitals were within normal limits (WNL) and the assessment was unremarkable, but this does not necessarily mean that the patient is not at risk of complications 4.
Risk of Complications
- The patient's refusal of treatment increases the risk of complications, including death or injury 2, 4.
- The patient's condition may worsen over time, leading to more severe consequences if left untreated 3.
- It is essential to inform the patient of the potential risks and consequences of not seeking treatment, as well as the benefits of receiving medical attention 5.
Patient Involvement in Care
- Patient and family involvement in escalation of care for acute life-threatening illness is crucial in ensuring timely and appropriate treatment 5.
- Interventions that increase patient and family involvement in care, such as education and communication, may improve patient outcomes and reduce adverse events 5.
- However, more research is needed to determine the effectiveness of these interventions in different settings and populations 5.