Nurs Ethics. 2026 Jul 14:9697330261463755. doi: 10.1177/09697330261463755. Online ahead of print.
ABSTRACT
BackgroundWhen patients refuse basic nursing care in the hospital setting, ethical tension arises between promoting patient dignity by providing hygiene and honoring bodily autonomy by respecting patient refusal of interventions.Research AimTo describe patient factors, clinical context, and the role of ethics consultation when basic care is refused to identify implications for future practice and/or policy.Research DesignWe conducted a retrospective qualitative content analysis of adult and pediatric ethics consultation documentation between January 2015 and December 2025 at a quaternary academic medical center, screening 2,381 consultations to identify cases involving refusal of basic nursing care. We collected patient demographics, admission and clinical information, reasons for ethics consultation, and actions taken by the ethics consultation service. Data were summarized via descriptive statistics, and categories were abstracted to develop a framework.Participants and Research ContextPatients receiving inpatient care at an academic medical center in the Midwestern United States.Ethical ConsiderationsUniversity of Michigan IRBMED deemed the study exempt (HUM00256591).Findings34 ethics consultations for 29 unique patients involved refusal of basic nursing care. Patients were adults (100%), with an average LACE score of 12.8; 15 (44%) had decision-making capacity. Care over objection was provided in 16 (47%) of cases, and physical restraints were used in 2 (6%) cases. Refusals involved hygiene (18, 53%), wound care (15, 44%), and repositioning (9, 26%), and occurred across nursing units and clinical services. Refusals were addressed through persuasion (9, 26%), soft paternalism (13, 38%), hard paternalism (3, 9%), or permitted refusal (9, 26%).DiscussionEthics consultation involvement resulted in four approaches to refusal of basic nursing care based on patient agency, decision-making capacity, and clinical context.ConclusionsWhen refusal results in dignitary or physical harm, healthcare teams should address barriers and encourage participation. In rare circumstances, care over objection is ethically permissible with multidisciplinary input.
PMID:42444500 | DOI:10.1177/09697330261463755
