Acta Med. 2010, 53: 239-242

Refusal of Treatment by Mentally Competent Patient: The Choice of Doctor-Patient Relationship Models

Andrei M. Beliaev

General Surgery Deparment, Middlemore Hospital, Auckland, New Zealand

Received April 5, 2010
Accepted August 19, 2010


1. Bandura A. Social Cognitive Theory of Personality. In: Pervin LA, John OP, editors. Handbook of Personality. Second ed. New York: The Guilford Press; 1999. p. 154–96.
2. Beauchamp TL, Childress JF. Principles of biomedical ethics. Fifth ed. New York: Oxford University Press; 2001.
3. Beck J.S. Cognitive Therapy: Basics and Beyound. New York: The Guilford Press; 1995.
4. Bertakis K.D., Roter D., Putnam S.M. The relationship of physician medical interview style to patient satisfaction. J Fam Pract. 1991;32(2):175–81.
5. Beutler LE, Groth-Marnat G, Rosner R. Introduction to Integrative Assessment of Adult Personality. In: Beutler LE, Groth-Marnat G, editors. Intergrative Assessment of Adult Personality. Second ed. New York: The Guilford Press; 2003.
6. Blacher RS. The psychological and psychiatric consequences of the ICU stay. European Journal of Anaesthesiology – Supplement. 1997 May; 15: 45–7. <>
7. Bond M, Gardner ST, Christian J, Sigal JJ. Empirical study of self-rated defense styles. Archives of General Psychiatry. 1983 Mar; 40(3): 333–8. <>
8. Cape J. Patient-rated therapeutic relationship and outcome in general practitioner treatment of psychological problems. British Journal of Clinical Psychology. 2000 Nov; 39(Pt 4): 383–95. <>
9. Carson JL, Noveck H, Berlin JA, Gould SA. Mortality and morbidity in patients with very low postoperative Hb levels who decline blood transfusion. Transfusion. 2002 Jul; 42(7): 812–8. <>
10. Coates J. Refusing emergency life-sustaining treatment. NZ Med J. 2001;114:18.
11. Emanuel EJ, Emanuel LL. Four models of the physician-patient relationship. In: Steinbock B, Arras JD, London AJ, editors. Ethical Issues in Modern Medicine. Sixth ed. Boston MA: McGraw-Hill; 2003. p. 67–76.
12. Groth-Marnat G. Handbook of Psychological Assessment. Fourth ed. Hoboken, New Jersey: John Wiley and Sons, Inc; 2003.
13. Huffman JC, Stern TA, Harley RM, Lundy NA. The use of DBT skills in the treatment of difficult patients in the General Hospital. Psychosomatics. 2003 Sep-Oct; 44(5): 421–9. <>
14. Johnstone M-J, Kanitsaki O. Health Care Provider and Consumer Understandings of Cultural Safety and Cultural Competency in Health Care: An Australian Study. Journal of Cultural Diversity. 2007 Summer; 14(2): 96–105.
15. Kaplan HI, Sadock BJ, Grebb JA. Kaplan and Sadock’s Synopsis of Psychiatry: Behavioral Sciences. Clinical Psychiatry. Seventh ed. Baltimore: Williams and Wilkins; 1994.
16. Kernberg OF. A Psychoanalytic Theory of Personality Disorders. In: Clarkin JF, Lenzenweger MF, editors. Major theories of personality disorders. New York: The Guilford Press; 1996. p. 106–40.
17. Kernberg PF. Mechanisms of defense: development and research perspectives. Bulletin of the Menninger Clinic. 1994 Winter; 58(1): 55–87.
18. Keszthelyi S, Blasszauer B. Challenging non-compliance. J Med Ethics. 2003; 29: 257–9. <> <PubMed>
19. Lenzenweger MF, Clarkin JF, Kernberg OF, Foelsch PA. The Inventory of Personality Organization: psychometric properties, factorial composition, and criterion relations with affect, aggressive dyscontrol, psychosis proneness, and self-domains in a nonclinical sample. Psychological Assessment. 2001 Dec; 13(4): 577–91. <>
20. Linehan M. M. Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press; 1993.
21. Little P, Everitt H, Williamson I. Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. BMJ. 2001 Oct 20; 323(7318): 908–11. <> <PubMed>
22. Madianos M.G, Papaghelis M, Ioannovich J, Dafni R. Psychiatric disorders in burn patients: a follow-up study. Psychotherapy and Psychosomatics. 2001; 70(1): 30–7. <>
23. Meissner W.W. Treatment of Patients in the Borderline Spectrum: An Overview. American Journal of Psychotherapy. 1993; 47(2): 184–93. <>
24. Mold J.W. Facilitating Shared Decision Making with Patients. American Family Physician. October 1, 2006; 74(7).
25. Richardson S., Williams T. Why is cultural safety essential in health care? Medicine and Law. 2007 Dec.; 26(4): 699–707.
26. Roth LH, Meisel A, Lidz CW. Tests of Competency to Consent to Treatment. Am J Psychiatry. 1977 Mar; 134(3): 279–84.
27. Selzer MA, Koenigsberg HW, Kernberg OF. The initial contract in the treatment of borderline patients. Am J Psychiatry. 1987; 144(7): 927–30.
28. Shea S.C. Psychiatric Interviewing: the art of understanding. A Practical Guide for Psychiatrists, Psychologists, Counselors, Social Workers, Nurses, and Other Mental Health Professionals. Second ed. Philadelphia: W.B. Sounders Company; 1998.
29. Simon J.R. Refusal of Care: The Physician-Patient Relationship and Decisionmaking Capacity. Ann Emerg Med. 2007; 50: 456–61. <>
30. Stewart M.A. What is a Successful Doctor-Patient Interview? A Study of Interactions and Outcomes. Soc Sci Med. 1884; 19(2): 167–75. <>
31. Stuhlmiller DFE, Cudnik MT, Sundheim SM, Threlkeld MS, Collins TE J. Adequacy of online medical command communication and emergency medical services documentation of informed refusals. Academic Emergency Medicine. 2005 Oct; 12(10): 970–7. <>
32. Tempereau CE, Grossman AR, Brones MF. Psychological regression and marital status: determinants in psychiatric management of burn victims. Journal of Burn Care and Rehabilitation. 1987 Jul-Aug; 8(4): 286–91. <>
33. Vaillant G.E, Bond M, Vaillant C.O. An Empirically Validated Hierarchy of Defense Mechanisms. Arch Gen Psychiatry. 1986 Aug; 43(8): 786–94. <>
34. Weiten W. Psychology: Themes and Variations. Sixth ed. Southbank (Australia): Thomson/Wadsworth; 2004.
35. Westaby S, Channon K, Banning A. To stent or not to stent?: A sterile debate.[ comment]. BMJ. 2007 Jul 21;335(7611):111. <> <PubMed>
front cover

ISSN 1211-4286 (Print) ISSN 1805-9694 (Online)