Self-Destructive Patients and Unreasonable Care Requests: Ethical, Moral, and Legal Issues

Physicians are encouraged to engage in shared decision making with their patients. In shared decision making, physicians and patients are both active agents with free will to make choices, and ultimately approve an agreed-upon medical choice. This provides a stark contrast with paternalism, a decision-making process in which physicians use a best-interest standard to make medical decisions for their patients. Paternalism was common in Western practice up until the 1970s, when a shared decision making model gained favor. Shared decision making can prove difficult when patients have unreasonable care requests, such as seeking treatment that is not medically necessary or that may even put them at risk of harm. Furthermore, patients are armed with more medical knowledge than ever, both from reliable and unreliable sources, due to the Internet. In this chapter, we explore ethical and legal issues surrounding patients making unreasonable care requests, and suggest several communication techniques to address such requests.