• Kylie Cheng, Anne Wand, Christopher Ryan, and Sascha Callaghan.
• Psychiatry Registrar, Prince of Wales Hospital, Randwick, NSW, Australia.
• Australas Psychiatry. 2018 Oct 1; 26 (5): 464-468.

ObjectivesThe assessment and management of a patient who refuses medical treatment requires clinical skill, and consideration of the relevant law and the patient's decision-making capacity. Psychiatrists are often asked to advise in these situations. We aimed to develop an algorithm describing the relevant legal pathways to assist clinicians, especially psychiatrists, working in New South Wales (NSW), Australia.MethodsWe reviewed the academic literature on treatment refusal, relevant legislation, judicial rulings and NSW Health policy directives and guidelines. We consulted with clinicians and representatives of relevant tribunals.ResultsWe developed an algorithm for managing patients who refuse medical treatment in NSW. The algorithm emphases the evaluation of decision-making capacity and tracks separate pathways depending upon a person's status under the Mental Health Act 2007 (NSW).ConclusionsThe algorithm provides a clear decision tree for clinicians responding to a patient refusing medical treatment in NSW.

19 keywords...

hide…