What ethical principles should guide my decision-making when managing a patient with conflicting treatment preferences?

When managing a patient with conflicting treatment preferences, your decision-making should be guided by the following ethical principles:

• Respect for patient autonomy: Offer the patient the opportunity to be involved in decisions about their treatment, establish their preferred level of involvement, and accept their right to make informed decisions, even if these differ from your own views, provided they have capacity ¹.
• Informed consent and shared decision-making: Clearly explain the condition, treatment aims, risks, benefits, and alternatives, including the option of no treatment, in a way the patient understands, and support them to express their values and preferences ¹,⁴.
• Assessment of capacity: Evaluate the patient’s capacity to make decisions using the Mental Capacity Act 2005 principles, ensuring they understand, retain, weigh information, and communicate their decision ¹.
• Non-maleficence and beneficence: Discuss the likely benefits and risks of treatments honestly and transparently, aiming to support decisions that promote the patient’s best interests while respecting their values ¹,².
• Transparency and documentation: Record discussions, decisions, and any concerns raised by the patient to support continuity of care and future consultations ¹,⁴.
• Flexibility and ongoing review: Recognise that patient preferences may change over time and provide opportunities to revisit decisions, ensuring care remains aligned with their evolving goals ²,⁴.

Applying these principles ensures ethical, patient-centred care that respects individual preferences and supports informed, shared decision-making.