Learning Objectives
After completing this application-based continuing education activity, pharmacists will be able to
| Recognize and define types and leading causes of treatment/medication refusal |
| Describe the ethical and legal principles associated with medication refusal, covert medication, and surreptitious prescribing |
| Determine treatment alternatives for patients with dietary, religious, or other restrictions |
| Identify and implement key components of a medication refusal protocol |
After completing this application-based continuing education activity, pharmacy technicians will be able to
| Recognize and define types and leading causes of treatment/medication refusal |
| Describe the ethical and legal principles associated with medication refusal, covert medication, and surreptitious prescribing |
| Determine treatment alternatives for patients with dietary, religious, or other restrictions |
| Identify and implement key components of a medication refusal protocol |
Release Date: October 17, 2023
Expiration Date: October 15, 2026
Course Fee
Pharmacists: $7
Pharmacy Technicians: $4
There is no grant funding for this CE activity
ACPE UANs
Pharmacist: 0009-0000-23-047-H05-P
Pharmacy Technician: 0009-0000-23-047-H05-T
Session Codes
Pharmacist: 20YC80-TRX39
Pharmacy Technician: 20YC80-XRT42
Accreditation Hours
2.0 hours of CE
Accreditation Statements
| The University of Connecticut School of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. Statements of credit for the online activity ACPE UAN 0009-0000-23-047-H05-P/T will be awarded when the post test and evaluation have been completed and passed with a 70% or better. Your CE credits will be uploaded to your CPE monitor profile within 2 weeks of completion of the program. |  |
Disclosure of Discussions of Off-label and Investigational Drug Use
The material presented here does not necessarily reflect the views of The University of Connecticut School of Pharmacy or its co-sponsor affiliates. These materials may discuss uses and dosages for therapeutic products, processes, procedures and inferred diagnoses that have not been approved by the United States Food and Drug Administration. A qualified health care professional should be consulted before using any therapeutic product discussed. All readers and continuing education participants should verify all information and data before treating patients or employing any therapies described in this continuing education activity.
Faculty
Danielle Haskins, PharmD
CVS Pharmacy Manager
Santee, CA
Ming May Zhang, PharmD Candidate 2022
University of Connecticut School of Pharmacy
Storrs, CT
Faculty Disclosure
In accordance with the Accreditation Council for Pharmacy Education (ACPE) Criteria for Quality and Interpretive Guidelines, The University of Connecticut School of Pharmacy requires that faculty disclose any relationship that the faculty may have with commercial entities whose products or services may be mentioned in the activity.
Danielle Haskins and Ming May Zhang do not have any financial relationships with ineligibile companies.
ABSTRACT
Based on the principle of informed consent, competent patients always
have the right to refuse medical treatment. Patients may refuse treatment
for a variety of reasons, including dietary restrictions, religious reasons, medical
misconceptions, a desire to avoid adverse effects, and mistrust of the medical
team. Patient refusals can create serious dilemmas in the healthcare setting. On
the one hand, clinicians have an ethical and legal obligation to honor patient autonomy.
On the other hand, a patient’s refusal of treatment often leads to adverse
medical outcomes, resulting in harm to the patient. Healthcare
professionals should search for acceptable treatment alternatives that honor patients’
wishes while meeting their medical needs. Every institution—whether in
the community, long-term care, or inpatient setting—should have a protocol to
guide and standardize the approach to managing treatment refusals. In complex
cases, it may be beneficial to use expert ethics consultations.
CONTENT
Content
ONLY PDF version is Available for this CE
Pharmacist Post Test (for viewing only)
Medication Refusal: Understanding the Why "They Just Say No"
After participating in this activity, pharmacists and pharmacy technicians will be able to
1. Recognize and define types and leading causes of treatment/medication refusal
2. Describe the ethical and legal principles associated with medication refusal, covert medication, and surreptitious prescribing
3. Determine treatment alternatives for patients with dietary, religious, or other restrictions
4. Identify and implement key components of a medication refusal protocol
1. Which of the following is an example of ACTIVE medication refusal?
a. A patient ingests her medication when the caregiver administers it, but secretly spits it out half an hour later.
b. A patient states that she does not wish to take her oral medication, then refuses to open her mouth to ingest the medication.
c. A patient initially refuses to take her medication, but concedes when the caregiver repeatedly asks her to.
2. A patient states that he is vegetarian and wishes to avoid animal products. Which of the following excipients is INAPPROPRIATE for this patient?
a. Gelatin
b. Peanut oil
c. Mannitol
3. Which of the following best describes motivational interviewing?
a. An interviewing style that involves the use of ethics counselors, who help healthcare professionals navigate complicated cases
b. The process by which patients are educated about a treatment’s risks, benefits, and alternatives
c. A behavioral technique that motivates patients to change by empowering them and motivating them with their own values
4. Which of the following statements is FALSE about the practice of covert medication?
a. It refers to administering medications without a patient’s knowledge, such as by concealing medications in food or drink.
b. It is justifiable in mentally competent patients who refuse treatment against medical advice.
c. It may be better received than more aggressive methods, such as forced injections.
5. A practicing Sikh patient tells you that her religion prevents her from consuming Medication X, which contains animal by-products. She wants to know what alternatives are available, and what she should avoid. Which of the following best describes her reasons for refusing Medication X?
a. Dietary restriction
b. Medical misconception
c. Mistrust of the medical team
6. A practicing Sikh patient tells you that her religion prevents her from consuming Medication X, which contains animal by-products. She wants to know what alternatives are available, and what she should avoid. Which is the best resource to refer her to?
a. Pillbox, so she can research medications’ ingredients and avoid those containing animal products
b. The primary literature and PubMed or GoogleScholar, so she can find the most recent data
c. The patient should not be referred; Medication X is the most effective option for her illness, and she should take it regardless of her beliefs
7. Why might an ethics consultation be useful in certain instances of treatment refusal?
a. Ethics counselors are authorized to make healthcare decisions on behalf of incompetent patients.
b. Ethics counselors are compensated based on patient outcomes, so they persuade patients to choose the most medically effective option.
c. Ethics counselors are trained in core ethics and healthcare competencies and can help navigate difficult situations.
8. Patient BT is newly diagnosed with a disease. His doctor recommends Treatment X and describes the treatment’s risks and benefits. BT refuses his doctor’s suggestion. Instead, he decides to try natural OTC products. This is an example of:
a. Beneficence
b. Primum non nocere
c. Autonomy
9. Patient BT is newly diagnosed with a disease. His doctor recommends Treatment X and describes the treatment’s risks and benefits. BT refuses his doctor’s suggestion. Instead, he decides to try natural OTC products. Which of the following is the LEAST appropriate response to BT?
a. Inform BT of the risks and benefits of OTC products, and show him how to interpret the Drug Facts labels.
b. Identify BT’s reason for refusal—ask about his beliefs, perceptions, and concerns. Counsel him accordingly.
c. Inform BT that you will request an ethics consultation to advise in this situation, which in your opinion is untenable.
10. Patient WG is prescribed a new medication and told to take one capsule twice a day. WG misunderstands—he takes two capsules once a day, instead. Which of the following best describes WG’s behavior?
a. Intentional non-adherence
b. Unintentional non-adherence
c. Passive refusal
11. Patient AU tells you, “Dr. S prescribed five different pills for me, but I’m not taking any of them. I’m a regular churchgoer and I know I should love and respect all people, but I don’t have a good feeling about Dr. S. I think she has it out for me. I’m going to get the meds from Dr. G instead.” Based on this statement, AU’s primary reason for refusal is:
a. Religious refusal
b. Lack of belief in the medications’ effect
c. Mistrust of the medical provider
12. Patient LG is a 5-year-old female who requires a life-saving blood transfusion. Her caretaker refuses to consent to the procedure since it goes against her religious beliefs. Which of the following statements is TRUE of this situation?
a. The attending physician must request an ethics consultation, since this is legally required for all cases involving a minor.
b. LG’s caretaker has the ultimate say in her medical decisions but LG’s doctors are ethically obligated do what is beneficial for the patient.
c. Since LG does not suffer from any brain disorders, she can make her own medical decisions. The medical team only needs LG’s consent, not the caretaker’s.
Pharmacy Technician Post Test (for viewing only)
Medication Refusal: Understanding the Why "They Just Say No"
After participating in this activity, pharmacists and pharmacy technicians will be able to
1. Recognize and define types and leading causes of treatment/medication refusal
2. Describe the ethical and legal principles associated with medication refusal, covert medication, and surreptitious prescribing
3. Determine treatment alternatives for patients with dietary, religious, or other restrictions
4. Identify and implement key components of a medication refusal protocol
1. Which of the following is an example of ACTIVE medication refusal?
a. A patient ingests her medication when the caregiver administers it, but secretly spits it out half an hour later.
b. A patient states that she does not wish to take her oral medication, then refuses to open her mouth to ingest the medication.
c. A patient initially refuses to take her medication, but concedes when the caregiver repeatedly asks her to.
2. A patient states that he is vegetarian and wishes to avoid animal products. Which of the following excipients is INAPPROPRIATE for this patient?
a. Gelatin
b. Peanut oil
c. Mannitol
3. Which of the following best describes motivational interviewing?
a. An interviewing style that involves the use of ethics counselors, who help healthcare professionals navigate complicated cases
b. The process by which patients are educated about a treatment’s risks, benefits, and alternatives
c. A behavioral technique that motivates patients to change by empowering them and motivating them with their own values
4. Which of the following statements is FALSE about the practice of covert medication?
a. It refers to administering medications without a patient’s knowledge, such as by concealing medications in food or drink.
b. It is justifiable in mentally competent patients who refuse treatment against medical advice.
c. It may be better received than more aggressive methods, such as forced injections.
5. A practicing Sikh patient tells you that her religion prevents her from consuming Medication X, which contains animal by-products. She wants to know what alternatives are available, and what she should avoid. Which of the following best describes her reasons for refusing Medication X?
a. Dietary restriction
b. Medical misconception
c. Mistrust of the medical team
6. A practicing Sikh patient tells you that her religion prevents her from consuming Medication X, which contains animal by-products. She wants to know what alternatives are available, and what she should avoid. Which is the best resource to refer her to?
a. Pillbox, so she can research medications’ ingredients and avoid those containing animal products
b. The primary literature and PubMed or GoogleScholar, so she can find the most recent data
c. The patient should not be referred; Medication X is the most effective option for her illness, and she should take it regardless of her beliefs
7. Why might an ethics consultation be useful in certain instances of treatment refusal?
a. Ethics counselors are authorized to make healthcare decisions on behalf of incompetent patients.
b. Ethics counselors are compensated based on patient outcomes, so they persuade patients to choose the most medically effective option.
c. Ethics counselors are trained in core ethics and healthcare competencies and can help navigate difficult situations.
8. Patient BT is newly diagnosed with a disease. His doctor recommends Treatment X and describes the treatment’s risks and benefits. BT refuses his doctor’s suggestion. Instead, he decides to try natural OTC products. This is an example of:
a. Beneficence
b. Primum non nocere
c. Autonomy
9. Patient BT is newly diagnosed with a disease. His doctor recommends Treatment X and describes the treatment’s risks and benefits. BT refuses his doctor’s suggestion. Instead, he decides to try natural OTC products. Which of the following is the LEAST appropriate response to BT?
a. Inform BT of the risks and benefits of OTC products, and show him how to interpret the Drug Facts labels.
b. Identify BT’s reason for refusal—ask about his beliefs, perceptions, and concerns. Counsel him accordingly.
c. Inform BT that you will request an ethics consultation to advise in this situation, which in your opinion is untenable.
10. Patient WG is prescribed a new medication and told to take one capsule twice a day. WG misunderstands—he takes two capsules once a day, instead. Which of the following best describes WG’s behavior?
a. Intentional non-adherence
b. Unintentional non-adherence
c. Passive refusal
11. Patient AU tells you, “Dr. S prescribed five different pills for me, but I’m not taking any of them. I’m a regular churchgoer and I know I should love and respect all people, but I don’t have a good feeling about Dr. S. I think she has it out for me. I’m going to get the meds from Dr. G instead.” Based on this statement, AU’s primary reason for refusal is:
a. Religious refusal
b. Lack of belief in the medications’ effect
c. Mistrust of the medical provider
12. Patient LG is a 5-year-old female who requires a life-saving blood transfusion. Her caretaker refuses to consent to the procedure since it goes against her religious beliefs. Which of the following statements is TRUE of this situation?
a. The attending physician must request an ethics consultation, since this is legally required for all cases involving a minor.
b. LG’s caretaker has the ultimate say in her medical decisions but LG’s doctors are ethically obligated do what is beneficial for the patient.
c. Since LG does not suffer from any brain disorders, she can make her own medical decisions. The medical team only needs LG’s consent, not the caretaker’s.
References
Full List of References
References
These can be found on the pdf version of the CE