How should a physician respond to an elderly patient's refusal of CABG for myocardial infarction?

From the Guidelines

The most appropriate response is D) "Let me again review with you the risks and benefits of this choice you are making to be certain you understand your decision." This approach respects the patient's autonomy while ensuring he is making an informed decision. The patient appears to have decision-making capacity as he understands his condition, the recommended treatment, and potential consequences of refusing CABG. He has expressed clear personal values about quality of life and has weighed the benefits of surgery against his preferences for avoiding a prolonged recovery period.

Key Considerations

• The patient's decision-making capacity is intact, as evidenced by his understanding of his condition and the recommended treatment 1.
• The patient has expressed clear personal values about quality of life, which should be respected by the physician 1.
• Reviewing the risks and benefits once more confirms the patient's understanding without being coercive or dismissive of his choice 1.
• Options that suggest the patient is depressed, pressure him to reconsider for his family's sake, or express discomfort with his decision would undermine his autonomy and fail to respect his values 1.

Ethical Principles

• Respecting patient autonomy is a fundamental ethical principle in medical decision-making, particularly when the patient demonstrates capacity 1.
• The physician's primary obligation is to the patient, and his wife's disagreement should not influence the patient's decision 1.
• The patient's right to refuse treatments and his understanding of the consequences of his decision should be respected and acknowledged in a written document 1.

From the Research

Patient Autonomy and Medical Decision-Making

The patient in question has made a decision regarding his medical treatment, opting for medical treatment only and declining the recommended coronary artery bypass grafting (CABG) procedure. This decision is based on his personal preferences and values, as he has expressed a desire to avoid the prolonged recovery time associated with CABG.

Respect for Patient Autonomy

• The principle of respect for patient autonomy is a fundamental aspect of medical ethics, as emphasized in the study by 2.
• This principle recognizes the patient's right to make informed decisions about their own medical care, free from coercion or undue influence.
• The study by 3 highlights the importance of patient-centered care and autonomy in decision-making, particularly in critically ill patients.

Informed Decision-Making

• The patient's decision should be respected, as long as it is informed and made with a clear understanding of the risks and benefits associated with each treatment option.
• The study by 4 emphasizes the importance of providing patients with accurate and unbiased information to facilitate informed decision-making.
• The physician should ensure that the patient has a thorough understanding of the treatment options and their potential outcomes, as suggested by 5.

Appropriate Response

• The most appropriate response in this scenario would be to respect the patient's autonomy and decision-making capacity.
• The physician should acknowledge the patient's concerns and values, and provide support and guidance to ensure that the patient's decision is informed and aligned with their personal goals and preferences.
• Option D, "Let me again review with you the risks and benefits of this choice you are making to be certain you understand your decision," is the most appropriate response, as it respects the patient's autonomy while ensuring that the decision is informed.