Systematic understanding of cancer patients who refuse treatment.

The refusal of treatment by cancer patients often takes place in a highly charged emotional context. Clinicians facing these situations frequently feel they are confronting an ethical dilemma involving whether to accept the patient's refusal or persuade the patient to a different position. However, most situations involving refusal of treatment involve issues of psychological distortions, interpersonal dysfunction, medical systems dysfunction, or psychiatric disorder, such as depression or organic mental disorder. By systematically reviewing these dimensions with the patient, many apparent dilemmas involving refusal of treatment will be resolved.