By Billy Hammond (Copyright AELS)

Treatment Refusal

In the US, medical students are taught that “A competent patient can refuse even life-saving treatment.”*

This falls under the heading of the “autonomy” of the patient, which means that a patient is free to make medical decisions based on personal reasons, even if the decision will result in death.

Informed Consent is related to the principle of autonomy in that the physician is required to discuss the following with the patient.

Benefits, Risks, Alternatives, Indications and Nature (BRAIN mnemonic) of the procedure.

The exceptions to providing informed consent are: Waiver, Incompetence, Therapeutic Privilege, Emergency (WIPE mnemonic) and Futility.

Waiver refers to the patient expressing the desire not to know; Incompetence is determined by a judge or circumstances (ie. coma); Therapeutic Privilege by the psychological condition of the patient (ie. the information might lead to suicide); Emergency by the patient being unable to provide consent (ie. a traffic accident that has resulted in unconsciousness); Futility by a treatment that has already failed or would do no good.

This differs from the situation in Japan where doctors and dentists sometimes do what they want without informing the patient. Just as an example, I had a dentist hit me with a shot of anesthetic and drill and fill a tooth about three years ago. Needless to say, I never went to her again!

*O’Connell, Theodore X.. Crush Step 1 E-Book: The Ultimate USMLE Step 1 Review . Elsevier Health Sciences. Kindle Edition.



この権利は患者の『自律』に含まれる。すなわち、患者は個人の理由で死に至るにしても医療判断ができる。これは『インフォームド・コンセント 』と関連する。

『インフォームド・コンセント 』では医師は次のことを患者に説明する義務がある。


『インフォームド・コンセント 』の例外条件は権利放棄、無能力、治療特権、緊急性及び無益である。




English books by Billy Hammond published by AELS



I. Majoh Gakuin and Hikari Juku – Japanese Witch Schools Trilogy

1. Majoh Gakuin & Hikari Juku – Japanese Witch Schools

2. Lost Witch (The second book)

3. Fate & Magic (The final book in the trilogy)

II. Brindle – Scryer Extraordinaire Trilogy

1. Brindle – Scryer Extraordinaire

2. Brindle – Scryer Extraordinaire – Returns

3. Brindle – Scryer Extraordinaire – Challenges (The final book in the trilogy)

III. Fantasy fiction set in Japan

1. 21st Century Ninja

2. Regressed

3. Japanese Woman

IV. Fantasy fiction set outside of Japan

1. Dimension Jumpers