Conditional Preferences and Refusal of Treatment or The Strange Case of Mary Northern
In this KosmosOnline Podcast, Jeanne Hoffman talks with Dr. Bill Glod about his paper, "Conditional Preferences and Refusal of Treatment," recently published in HEC Forum.
Abstract:
In this essay, I will use a minimalist standard of decision-making capacity (DMC) to ascertain two cases in the medical ethics literature: the 1978 case of Mary C. Northern and a more recent case involving a paranoid war veteran (call him Jack). In both cases the patients refuse medical treatment out of denial that they are genuinely ill. I believe these cases illustrate two matters: (1) the need of holding oneself to a minimal DMC standard so as to make as salient as possible the patient's own reasons for sometimes unusual treatment denials; (2) the need for clinicians and other relevant parties to exercise great sensitivity toward engaging, on the patient's own terms, idiosyncratic treatment refusals through regard for what I will call the patient’s conditional preferences. These are particularly relevant matters when a patient’s DMC is questionable yet he/she registers what may well be his/her settled preferences