Confronting Patients' Refusal to Undergo Treatment: A Cross-Sectional Study of Ethical Attitudes and Intended Behaviour Among Lithuanian Physicians.

INTRODUCTION: Refusal to undergo treatment, including one of its manifestations, discharge against medical advice, must be informed, just as consent is, which is considered a core ethical principle in contemporary medical ethics. The aim of this study was to explore physicians' attitudes and intended behaviour toward patients' refusal of necessary treatment and to identify factors associated with their clinical decisions in such situations. METHODS: A cross-sectional anonymous online survey of 393 physicians working in Lithuanian public hospitals was conducted between November 2020 and March 2021 using the secure national platform manoapklausa.lt. A convenience sampling strategy ensured representation of both large university and smaller regional hospitals, and all responses were complete due to mandatory fields in the questionnaire. RESULTS: Most physicians (85%; 95% CI 81.2 to 88.5) have encountered situations of refusal to undergo treatment. Women (p < 0.05) and senior physicians (aged 51 years and over) (p < 0.05) tend to apply treatment without patients' consent more often in all clinical cases, especially in surgical ones (VN1 and VN2). Difficulty in the decision-making process was associated with chronic conditions and the influence of individual religious beliefs. Insufficient patient information on the intervention was indicated as the main cause of refusal to undergo treatment (62.9%; 95% CI 58.0 to 67.4). Refusal to undergo treatment was associated with physicians' concern about the patient (57.5%; 95% CI 52.7 to 62.3) and anxiety (38.9%; 95% CI 34.1 to 43.8). Physicians' attitudes towards patients' refusal to undergo treatment reflect paternalistic patterns and are mainly associated with the physician's older age, gender, and duration of professional experience. Insufficient patient information on the intervention was indicated as the most important factor determining patients' refusal to undergo treatment. Under Lithuanian law, patients have a clear legal right to refuse treatment, and physicians who proceed without consent may face criminal liability. CONCLUSIONS: Our findings show that, despite the legal restrictions, many physicians would still choose to treat against a patient's will, reflecting a persistent paternalistic attitude even in the presence of clear legal prohibitions.