It becomes a regular occurrence for patients to refuse treatment, many different reasons surround their decision to refuse treatment some due to pain some due to not feeling up to it and some merely just because they do not feel like it. On the opposite end of the spectrum there are patient who refuse treatment because they do not want to recover, or they have been fighting what they feel is a losing battle for to long and have given up the fight and come to terms with the fact that they are not going to recover in their opinion.
What do you do as a therapist, a major part of our job entails motivating people to do things that they never thought was possible. Motivating them to get up even when they think it is impossible, pushing them further and further each day so that they can get to a point where they are stronger than they were yesterday. Now how do you motivate the unmotivated, the one who has given up and the one who wants to die.
If I had to use an example of a patient who has attempted suicide. This patient does not want to live, why would they want to be treated? Is it okay to just leave them and allow them to decline knowing that they are only going to get worse and will inevitably get what they wanted. I would hope as a therapist I would be able change the patients mind to motivate them that they can get better, strive to make a positive impact on their life I would hope that they would find a will to live again. I hope I could make that impact, its something that runs through my mind a lot. I have not had such an encounter yet but I assume there will be an encounter along the way. Depression plays a major role in these patients decision to take their lives, finding someone to give them hope at a point in their life where they have no hope at all is something that I hope I can be that light that lifts them up or at least a part of the team that helps these patients find hope.
International Ethics Project 
Hi Dimitri, I enjoyed reading your blog post on refusing treatment and attempted suicide.
The example you’ve used is quite an ethical dilemma.
What I would like to challenge you with is: What do you think is if you were to be in a position where you had lost hope and a reason to continue forward with life, what would be the key elements and the important role players to assist you in ‘finding hope’/ achieving motivation? How do you think these role-players can be successful in influencing patient’s life within the given time frame? Also what are the key principles or deeper reasons for drive/passion and hope/motivation, and how does a physiotherapist incorporate this in to practice.
Something I appreciate from this piece is your ability to foresee a possible dilemma in the future and try to understand the reasons for the situation as well as your attempt to find a way to make an impact into motivating the patient.
I myself have not been placed in the situation where my patient has refused treatment whilst having the understanding of the consequences. I have gained understanding and growth from your writing, thank you.
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Hello, Dimitri. I agree that our role as Physiotherapy professionals is to make the patient overcome their disabilities, but in some cases we need to be realistic about the condition of improvement of the patient. Sometimes, it is not of his own accord that he is in treatment and it may be that for him treatment is a way of prolonging his pain, as in cases of patients with terminal illnesses or imprisonment syndrome. I believe that the pursuit of what is good is very individual and we must accept it even when we do not agree.
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