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Decision-making capacity and refusal of care — RACP Adult Medicine MCQ

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ModerateEthics and public healthDecision-making capacity and refusal of careRACP Adult Medicine

A 69-year-old man with pneumonia refuses intravenous antibiotics. He can explain his diagnosis, the proposed treatment, the risks of refusal and his reasons, which are consistent with long-held values. He is not delirious and there is no coercion. What is the most appropriate management?

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Correct answer: E — Respect the refusal, document capacity assessment and offer alternative care

A capacitated adult may refuse recommended treatment, even if clinicians consider the decision unwise. The task is to assess and document capacity, ensure informed refusal and offer alternatives. Family preference, mental health legislation or clinician disagreement does not override capacity.

Reference: Australian Medical Council Good Medical Practice; state capacity legislation