You Can’t Stop Me From Caring: Ethical obligations, considerations, and recommendations in responding to refusals of basic care.

Abstract: In this session, panelists will explore the ramifications of refusal of basic care. This is an under-recognized and underappreciated problem in inpatient settings with significant impact. Basic care meets essential human needs in a compassionate manner with respect and dignity. Basic and ordinary care, aligned with current treatment goals, are of critical benefit and low burden to the patient. Basic care may include hygiene, dressing changes, repositioning, pain management and nutrition. Constraints on standards of care in clinical practice such as this type of refusal may develop into moral distress for clinicians. Exploring the role each team member has in the plan of care is essential to promoting dignity and humanity of the patient while also maintaining the moral obligations of the healthcare team. We will critique and analyze: refusal by decisionally capable patients; overt refusal by incapacitated patients, and surrogate refusal. We will examine the ethical and professional responsibilities of stakeholders and organizations to provide basic care in these cases including legal, risk, and social concepts. We will specifically explore the patient or surrogate’s role in these refusals. Recommendations will be grounded in beneficence and nonmaleficence, mitigating harms and eliciting the values and complexities underlying the refusal. Approaches will include acknowledgement of implicit biases, need for trauma informed care, and response to issues of healthcare inequities and injustice that contribute to mistrust. The ethics committee plays an essential role in establishing a culture in which all aspects of the refusal are considered to provide holistic, humane, basic care.