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Decision-making capacity refusal — RCPSC IM MCQ

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HardGeneral IM/Ethics/CanMEDSDecision-making capacity refusalRCPSC IM

A capable patient with severe pneumonia refuses admission after accurately explaining the diagnosis, expected benefits, risks and alternatives. What is the best next step?

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Correct answer: D — Respect the refusal, document capacity and arrange feasible follow-up

The best answer is “Respect the refusal, document capacity and arrange feasible follow-up”. A capable adult may refuse recommended treatment even when the decision carries substantial risk. The clinician should confirm voluntariness and understanding, document the process, provide safety-netting and reduce feasible harm. A written safety plan should specify warning symptoms, antimicrobial access, review timing and when emergency reassessment is required.

Reference: Canadian Medical Protective Association, Consent: a guide for Canadian physicians: https://www.cmpa-acpm.ca/en/advice-publications/handbooks/consent-a-guide-for-canadian-physicians