Scott is a ventilator dependent. He suffered a total transaction of spine at c4. he is only 17.

Scott pleads with his caregivers to be taken off the ventilator. “I have the right to refuse
treatment! I don’t want to be trapped in this body!” does he have the right to refuse treatment
though he is not terminally ill or immediately dying?

I. Introduction
One of the greatest dilemmas for health care provider occurs when a
patient refuses medical treatment that is necessary to sustain life and health. The
important part of treating a patient is the decision if they want to accept or to
refuse the treatment because health care professional are required to obtain
informed consent of patients before initiating treatment.
In this case study, we address the issue of whether adolescents, as a rule,
possess capacity of sufficient quality that it should be respected even in the case
of life-altering medical decisions. We consider the traditional approach to
determining when adolescents should have their decisions respected, an approach
that focuses on establishing capacity under a traditional informed consent and
explore the implications for adolescent decision-making capacity.
II. Fact of the Case
a. Personae
1. Patient
 Scott, 17 year old. He is suffering from total transaction of spine at c4 and
he is refusing the treatment.
2. Relatives
 Parents ( informed the parents about the refusing of the treatment of their
son and ask for their decision also)
3. Health Care Providers
 Caregivers, they are the one that takes care of scott conditions.
b. Setting
The case happened in a hospital
c. Summary
Scott is a 17 years old who suffered in a total transaction of spine at c4 and he is a
ventilator dependent. He wants to refuse the treatment because he feels like that
he was trapped in his own body. He asked the caregivers to stop the treatment by
taking off the ventilator.
d. Definition of terms
1. Ventilator- is a machine designed to provide mechanical ventilation by
moving breathable air into and out of the lungs, to deliver breaths to a patient
who is physically unable to breathe, or breathing insufficiently.
2. Transaction of spinal cord- Traumatic spondyloptosis is defined as greater
than 100% of traumatic subluxation of one vertebral body in the coronal or
 sagittal plane which usually causes the complete transaction of spinal cord. It
is a rare but severe injury of the vertebral column
3. C4- This is the level of the cervical spine contains nerves that run to the
diaphragm which help us to breathe by the contacting and pulling air into the
lungs..
4. Treatment – is a medical care given to a patient for an illness.
5. Pleads – make an emotional appeal
III. Ethical Issue
How do health care providers decide whether to go ahead and treat a patient or
discontinue the treatment with a person who lacks decisional capacity because of his
age and condition.
IV. Analysis
Option A: Accept what the patient wants and discontinue the treatment
 Everyone have the right to choose what will be done to their own health.
 Everyone have the right to refuse unwanted medical treatment
 We consider the conditions and the feeling of the patient
 We respect the autonomy of the patient to decide on his own condition.
 We are following the legal actions.
 Forcing treatment is medical paternalism
Option B: Ignore the decision of the patient and continue to deliver the treatment.
 Treatment would save the patient life
 The patient is not in the right age to decide on his own
 We consider the effect to the patient
 We encourage the patient to continue his treatment
Option C: Informed the parents and respect the decision of the parents
 We respect the right of the parents.
 We consider the capacity and age of the patient
 We are following legal actions
V. Resolution
We consider the all aspect in refusing treatment of the patient and legal actions. We
have decided as a group to informed and respect the decision of the parents about
refusing the treatment of her son.
VI. Substantiation
The decision of the parents is important because the patient is not in the right age and
he is lack in decisional capacity because of her emotions. Refusing treatment and
informed consent is the right of patient but we must consider the decisional capacity
of individual when it comes to health conditions. The refusal of the treatment
consider the patient capacity, delivery information and the patient’s autonomous of
choice when they are in right age and with support of their parents.
VII. Appendix
PATIENTS RIGHTS
Hits: 79661
. Right to Informed Consent. - The patient has a right to a clear, truthful
and substantial explanation, in a manner and language understandable to the
patient, of all proposed procedures, whether diagnostic, preventive, curative,
rehabilitative or therapeutic, wherein the person who will perform the said procedure
shall provide his name and credentials to the patient, possibilities of any risk of
mortality or serious side effects, problems related to recuperation, and probability of
success and reasonable risks involved: Provided, That the patient will not be
subjected to any procedure without his written informed consent, except in the
following cases:
a) in emergency cases, when the patient is at imminent risk of physical injury,
decline Of death if treatment is withheld or postponed. In such cases, the
physician can perform any diagnostic or treatment procedure as good practice
of medicine dictates without such consent;
b) when the health of the population is dependent on the adoption of a mass health
program to control epidemic;
c) when the law makes it compulsory for everyone to submit a procedure;
d) When the patient is either a minor (under 18yrs old), or legally incompetent, in
which case. a third party consent Is required;
Informed consent shall be obtained from a patient concerned if he is of legal age and
of sound mind. In case the patient is incapable of giving consent and a third
party consent is required. the following persons, in the order of priority stated
hereunder, may give consent:
i. spouse;
ii. son or daughter of legal age;
iii. . either parent;
iv. brother or sister of legal age, or guardian
If a patient is a minor, consent shall be obtained from his parents or legal guardian.
If next of kin, parents or legal guardians refuse to give consent to a medical or
surgical procedure necessary to save the life or limb of a minor or a patient
incapable of giving consent, courts, upon the petition of the physician or any person
interested in the welfare of the patient, in a summary proceeding, may issue an order
giving consent.
VIII. Bibliography
https://www.norcal-group.com/library/when-patients-refuse-treatment-medical-ethics-
issues-for-physicians
https://www.medscape.com/viewarticle/882741
https://samch.doh.gov.ph/index.php/patients-and-visitors-corner/patients-rights
Our Lady of Fatima University – Valenzuela Campus
120 MacArthur Highway, Valenzuela, 1440 Metro Manila

Refusing treatment

A Ethics Case Study Presented to the

Faculty of the College of Nursing

Our Lady of Fatima University

Valenzuela City

Submitted by:

Balang Eunice Valerie

Criste, Kenneth

Francisco, Jeanne

Geslaga, krisca

Gomez, angelica gale

Maglasang, marybel

Manguda, aliha

Tan, crissel

Vasquez, john russel

Submitted to:

Mr. Mel Garcia