When Respecting “No” Leads to Harm: A Collaborative Approach for Ethical Management of Basic Care Refusal

AbstractIn this article we will explore the refusal of basic care, an underrecognized and underappreciated challenge in inpatient healthcare settings. While basic care is generally seen as the obligation and direct responsibility of nurses, refusals of basic care have wide-ranging implications for patient outcomes and must be addressed by the entire care team. First, we define basic care and assert the premise that patients have an essential interest in basic care as a human good that is representative of respect and dignity for persons. Second is the premise that there is a professional obligation to ensure the patient's safety and well-being that arises from the fiduciary relationship established in the care setting. Building from these two premises, we propose a framework for responding to basic care refusals. Multidisciplinary care teams can utilize this framework to identify and address the cumulative harm that may occur with repeated refusals, evaluate management strategies for both active and passive refusals, and determine when it may be ethically justifiable to compel care over refusal.