Ethical analysis of a case of treatment refusal: respect for patients’ autonomy in the context of the Iranian clinical environment

Afsaneh  Sadooghiasl; Shiva  Khaleghparast; Ehsan Shamsi  Gooshki

doi:10.18502/jmehm.v17i14.18666

Afsaneh Sadooghiasl Assistant Professor, Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran. MSc Student in Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran. Visiting researcher, Institute for Ethics and History of Health in Society, Augsburg University, Augsburg, Germany.
Shiva Khaleghparast Associate Professor, Cardiovascular Nursing Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Ehsan Shamsi Gooshki Associate Professor, Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran. Lecturer, Monash Bioethics Center, Monash University, Melbourne Australia

DOI: https://doi.org/10.18502/jmehm.v17i14.18666

Keywords: Clinical ethics; Medical ethics; Personal autonomy; Treatment refusal; Pregnancy; Patients’ Right.

Abstract

Refusal of treatment is a challenging issue in clinical ethics, especially in the context of pregnancy care. However, respect for patient autonomy remains a fundamental ethical principle, as outlined in codes of conduct and patient rights within healthcare services. The aim of this case presentation was to critically analyze a clinical ethics case within the Iranian context using an ethical framework. A theory-based framework was used that integrates the principlism approach, based on prima facie moral norms, with the moral development theories of Lawrence Kohlberg and James Rest to analyze this case. Mrs. M, a 38-year-old pregnant woman with acute myeloid leukemia, chose to continue her pregnancy until 32 weeks, despite medical advice, before starting her cancer treatment. The decision, influenced by the significance of her first pregnancy after costly infertility treatments, presented a complex ethical dilemma. The patient's autonomy was respected by the medical team, and treatment was delayed until the pregnancy was terminated at 33 weeks, ensuring both maternal and fetal care. The case underscores the ethical challenges of balancing patient autonomy with medical beneficence, highlighting the importance of trust and informed consent.