The doctor refuses to perform the operation, what should I do? Doctors refuse to operate due to a weak heart. Can I refuse surgery if people who are dissatisfied with legal claims operate on me?

Surgical operations have always been considered an extreme, exceptional way of interfering with the functioning of the body. But now, thanks to someone’s light hand, operations are literally “distributed” right and left. What's the matter, we'll have to figure it out...

About the questionable benefits of some surgical interventions

Surgical operations have always been an extreme, exceptional way of interfering with the functioning of the body, justified only in cases of severe injuries or emergency care. However, recently, the attitude in society towards operations, with the help of someone else, has changed to a favorable one, and operations are literally “handed out” right and left. What is the matter here and how justified is such “care” of medicine for people? We'll have to figure it out...

Recently, doctors are increasingly suggesting that older people undergo surgery. Yes, not just one, but most often, a whole series of operations in different places of the body “for medical reasons.” And this is no coincidence: for surgical interventions, medical institutions are allocated budget money - quotas.

In Soviet times, permission to operate went through a multi-stage filter of decisions of various medical specialists, who weighed all the possible consequences of the operations. Surgery was not as common as it is now.

Everything has changed literally in the last decade. Quotas, that is, financial assistance from the state for operations, added extraordinary popularity to the latter. Word "quota" acquired magical significance. Older people think something like this: “The state takes care of me, allocates money specifically for me, and I should/must take advantage of this chance.”.

Often older people agree to surgery due to lack of attention from loved ones and their children. Then commercial interest They trustingly accept medical institutions as sincere concern for their health. It is also no secret that in Soviet times people were taught to think, first of all, about their labor and professional efforts for the good of the Motherland, about fulfilling the production plan, and not about their own health. It was tacitly understood that medicine, available to everyone in the country, protects health and will help a person at the right time.

But with the advent of the capitalist economy, medicine changed its functions, becoming a tool making money in front of people in their helpless state. Thus, quotas apply for two days after the operation, and then caring for the patient costs a person "at your own expense". True, the most honest doctors warn: if you have not taken care of your health all your life, we cannot cure you overnight. In this case, in our opinion, the following explanation is suitable: in order to cure you, you need to be born again. Doctors don't know how to do this.

Let’s not argue: perhaps many of the surgical interventions are still necessary for people. For example, removal of the appendix, which today medicine can only perform surgically; or removal of various growths in organs that arise abundantly due to unfavorable social and environmental conditions; or dental procedures.

However, I would like to draw attention to a specific category of elderly people over 75 years of age, burdened with various signs of ill health. By turning to medical institutions, these people, whose memory is still fresh of Soviet propaganda about the value of each person for the state, hope to receive qualified medical care, sympathy and pity from doctors in their painful condition.

People are not always fully aware cynicism of the market economy, which is indeed not easy for a normal person to get used to, that assistance will be provided to them in exact accordance with the thickness of their wallet. The market economy with its cannibalistic laws makes doctors heartless traders and clever manipulators. Finding themselves in a helpless position and completely dependent on such doctors, patients experience a systematic “promotion” of their solvency to dangerously low levels...

First of all, what awaits people when they go to medical institutions is full medical examination. Of course, everyone decides whether they need to undergo the full range of very tedious, queuing, and sometimes humiliating initial examination procedures. Patients waiting their turn to see a doctor turn out to be very talkative, captivatingly talking about their “adventures” in the “field” of operating tables in medical institutions.

As an involuntary listener to their stories, I was often surprised at how fairly young people, in full confidence in the correctness of their decision, repeatedly “corrected” the nature of their body with the help of doctors through surgical operations. In my outside opinion, in these operations there was no reason. It was enough to do several sessions of a thorough massage for problems with blood vessels or a course of appropriate therapeutic exercises for damage to certain joints.

In our article we will look at various options for surgical interventions that are offered beyond measure by the medical field to rather naive and gullible elderly people.

We are talking about operations on blood vessels, due to varicose veins. Armed only with logic and abstracting from medical terminology, let’s try to reason: what is varicose veins? What is its reason?

The formation of tubercles on the surface of blood vessels, most often on the legs, is not a rare occurrence. It occurs due to systematic, excessive physical exertion: standing for long periods of time, carrying heavy loads over long distances. But something else is interesting: how does blood behave in the vessels? Due to constant physical stress, blood, having a tendency to thicken with age, accumulates more and more in the working organs - the vessels become lumpy, bubbly, showing blue through the skin.

That is, the bloodstream itself creates convenient “banks” for itself, like a river, so that the heart can pump the maximum amount of blood, satisfying the person’s need for excessive labor efforts. That's right, a living organism adapts, all its functions are stabilized, creating additional opportunities for life. The circulatory system adapts to extreme “horse” loads in such an unaesthetic way. Poets and writers of the century before last wrote about the hard work of Russian women.

What can happen during vascular surgery?

The operation involves removing deformed areas of blood vessels. Then, the remaining unchanged volume of blood (thick - in older people) will circulate through a smaller volume of the bloodstream, due to the removed vessels. In this case, doctors console: "Blood will find its way" . So she finds it, creating numerous hematomas in the capillaries when they rupture and form the so-called. “stars”, and in larger vessels thickenings are formed, the blockage of which is fraught with death.

In addition, as is known, the walls of blood vessels in old age lose elasticity, become fragile and brittle. In addition, the heart must work “to the limit,” pushing a large volume of blood into “smaller” vessels.

Consequences such an operation, even with its high-quality performance, are obvious: increased cardiac and vascular pressure, shortness of breath, increased risk of blood clots, and, most certainly, - reduction in life expectancy.

Verka Skvortsova - Minister of Health of the Peoples of Russia

Yes, it's still worth taking into account the work lymphatic system. It is known that in old age, lymphatic vessels and nodes degrade, that is, they become deformed and even disappear, so entire areas of the body are left without lymphatic vessels. The phenomenon of stagnation of lymph in the extremities is also possible - lymphostasis. And lymph, as you know, cleanses the entire body of “toxins.”

After surgery, due to a general weakening of the immune system, the body may be unable to fight its own internal microbes, not to mention those introduced from the outside. The doctors will immediately follow with powerful antibiotic therapy, which still needs to be endured. In addition, as the surgeons themselves admit, they do not always sew together blood vessels, and they never sew together lymphatic vessels.

Knowing this, people should think about the consequences of medical actions. Therefore, if you are elderly (70-75 years or more), varicose veins, but the veins do not hurt or bother you, if you have hypertension, signs of poor functioning of the lymphatic system, do not rush to undergo vascular surgery.

Especially harmful should be recognized as surgical joint replacement surgeries, most often, hip and knee, in fairly elderly patients. Doctors literally “distribute” them according to quotas “right and left,” regardless of the patient’s age and general state of health. And older patients are already “breathing their last breath”...

It is true that there are restrictions on surgical interventions, but they can be overcome again... with the help of operations. For example, if a person has varicose veins, they will first offer to remove the deformed vessels and only then will they allow endoprosthetics (replacement) of the joint. True, with lymphostasis of the lower extremities, they will not work on the affected leg, but they will work on the other, healthy one.

You will say: but a person can refuse an operation, this is his decision, isn’t it?

The fact of the matter is that it is very difficult to refuse. Why? Imagine, a working man has received neither attention, affection, nor respect at work and at home all his life. Accumulated attention deficit is difficult to overcome. And then a person comes to a medical institution, and here - attention, care, affectionate intonations, kind words...

Special mention should be made of psychological methods of influence doctors per patient. Phrases like: “It’s scary to live at your age” or “What will happen to you next?”- act flawlessly, driving the patient into truly animalistic fear for his life.

Under the influence of fear, people are ready to pay for their treatment all the sums of money accumulated during their lives, which were initially provided for “for a rainy day.” Doctors become skilled managers and marketers in promoting their services. They use it to deceive "medical magic", turning off a person’s mind, and people agree to any manipulation without hesitation.

Some operated patients become advertisers of medical services - "by my own stupid will", or "asked"... This can happen when the operated patient suddenly discovers partial or complete insolvency, but he needs more funds for post-operative rehabilitation. Then network marketing methods come into play: come yourself - bring someone else.

Moreover, the people themselves play into the hands of the doctors, pushing each other in their determination to “perform” the operation. There is even competition between them: who can “inflict” more operations on themselves. Surgical operations become for people the subject of investment in vital activity, a significant achievement, a matter of “valor and heroism” and even the meaning of life. Apparently, a person does not find another field or social institution to apply his strength, or there are no such institutions, but this is a separate conversation. In such a situation, an elderly person should be guided by common sense, have a strong core of spirit and willpower, so as not to fall under unwanted outside influence.

Surgical operations are performed according to mechanistic canons and are characterized by instrumentality: the excess is removed, the unnecessary is replaced, the missing is inserted, sewn on. These steps are pretty easy to understand. And no soulfulness, everything is according to standards. For example, knee replacement involves the following steps: an incision is made in the soft tissue along the joint, the soft tissue is moved to the side, exposing the knee joint. Then the joint is sawed on both sides - on top along the femur, on the bottom along the shin, the knee with the “cup” is thrown out. Instead, a pre-selected prosthesis made of metal and plastic is inserted. The prosthesis is fixed in the patient’s joints, covered with soft tissue, and the skin is stitched.

Doctors make money from our diseases! Therefore, they cannot be cured in principle!

What consequences are possible? as a result of such surgical “sacred rites”, about which doctors try to talk less? For the sake of authenticity of the stated and personal belief, we conducted our own sociological research and met with some people who had undergone the operation.

The first and inevitable consequence. Adaptation of joints to the prosthesis, which acts as a large foreign body, foreign mechanism, adaptation of soft tissues to the proximity of a metal-plastic device. How often, having received a splinter in our hand, we strive to get rid of it, otherwise the body itself gets rid of the splinter by breaking through purulent inflammation at the site of the lesion. However, a joint prosthetic implant is not a splinter that can be easily removed; and why change it if the “native” joint cannot be returned.

In an organism that recognizes a foreign organ, pain begins. The pain can last for several months, depending on the speed of addiction. There is a special medical term from transplantology - tolerance, which means the body's inability to distinguish foreign organs. To achieve a state of tolerance, the patient is prescribed painkillers and injections, which are known to contain narcotic and therefore toxic substances that kill nerve cells and fibers that signal pain. The state of tolerance (tolerance) is achieved through the gradual suppression of the body's immune system by painkillers and toxic substances.

Decreased immunity opens the way to various infectious diseases and related complications. Therefore, patients who have undergone joint surgery take painkilling injections and pills for years to “put the body to sleep” and make it not see the foreign body. There is a known case of death of a not very elderly woman, just a year after the operation. Apparently, addiction has not occurred, and consciousness cannot be turned off; it signals a “stranger” in the body. Another woman, after two operations on her legs, right and left, constantly experiences pain that was there before the operation. This suggests that the operation is not capable of eliminating pain; this is not its function.

Second consequence. These are inflammatory processes in the joint and soft tissues, due to infection during surgery or due to the inevitable decrease in the patient’s immunity. In this case, doctors prescribe antibiotic therapy to relieve inflammation. There are several cases where people, after surgery, return to a medical facility to relieve the inflammatory process, but this time entirely at their own expense.

Third consequence. Those who have “turned off” their consciousness and coped with getting used to a foreign body, overcame (or avoided) the inflammatory process, experience a deficit in the emotional sphere. Apparently, internal discomfort cannot be avoided. We are talking about people who previously “gushed” with enthusiasm and gaiety. Now - pallor of the face and skin, a “stone mask” on the face. The impression is as if you are talking to a mummy...

For those who are trying to keep their soul (and body) alive, it is worth thinking about the consequences. In any case, a person experiencing constant discomfort becomes nervous, irritable, his character deteriorates, and it is difficult to be around such a person.

Fourth. Have you forgotten, having undergone the operation, that the prosthetic leg should still be developed and thereby, to some extent, repeat the feat of the legendary pilot Maresyev? After the operation you will have to learn to walk again, first on crutches, train the leg muscles so that they can bend the leg in the prosthetic knee, otherwise the leg will remain extended, like a stick or a pistol. One of the women we interviewed admitted that if she accidentally falls, then can no longer get up on his own. There is physical helplessness.

Let us note in passing: human muscle tissue builds up very difficult and slowly, and in older ages, on the contrary, there is a loss of muscle mass. So it will not be easy to provide a “muscular frame” to the prosthesis, even if you heroically develop your legs. Here you will need hard work and discipline.

Doctors are very dangerous to our health...

A separate issue is the patient’s excess weight. Doctors often advise patients to lose weight before undergoing arthroplasty surgery. The advice is correct in itself, if you implement it very slowly, over several years. However, any sudden weight loss at an older age is undesirable: a decrease in hemoglobin in the blood is possible, that is, anemia, anemia. It is also important that the preparatory procedures and the operation itself are very stressful for the patient.

People who have undergone surgery expect that after surgery they will regain the healthy limbs they had when they were twenty. But miracles don't happen. According to our observations, these people move the same way as before the operation: those who limped still limped; Those who had joint pain before surgery still have pain after. And those who haven’t developed their legs after surgery often end up even in a walker!

It is clear that such operations are often performed by people who have little knowledge of the medical topic, are not prepared in the volitional sense and, most definitely, have not been concerned with their health throughout their lives. Thus, an incorrect gait “stepping on the entire foot with a fall” and the absence of special shoes with shock-absorbing, step-softening soles, multiplied by years of life, do their job - the joints inevitably become deformed and destroyed. And no “fastum gels” will help here.

It is known that the skeletal system loses calcium and other minerals with age and becomes fragile. And having performed joint replacement surgery in one place, you will not stop the negative processes of degeneration in the entire skeletal system...

This is a very unpleasant thing to understand. But there is still no need to worry: a person is designed in such a way that with “tolerable” care for his health, his functions and organs should be enough for his entire life. And one more thing: while a person is alive, the processes of regeneration of tissues and organs do not cease to occur even in older ages, although slowly. This should be remembered. Actually, the difference between an old and a young person lies in the rate of bioregeneration of tissues and body systems.

Your health is in your hands. To save joints and the musculoskeletal system, it is necessary to maintain a motor regime. Take your ski poles in your hands and go Nordic walking. Calcium in the bones is absorbed only with active movement.

It should also be mentioned the existence social diseases(however, in modern society, all diseases have social or environmental causes), when health is restored not by surgery, but by changing lifestyle and nutrition.

Yes, when pulmonary tuberculosis Removing part of the lung is not at all necessary and not even desirable. The disease goes away on its own with increased, high-quality and varied nutrition, good living conditions and adherence to a daily routine. In case of operation by part or half of a lung, a person is forever deprived of some part of his physical activity, ability to work and, in general, vitality.

But this is not explained to patients. On the contrary, they are pushing for surgery, citing the fact that microbes in the lungs are multiplying every day... And again the same methods: fear and lack of time.

Let's summarize what has been said. Medical operations are not always necessary for older people. The main thing is to stabilize the general condition of the body at an acceptable, not better, level. "Best the enemy of the good". A negative consequence of surgical interventions is the obvious shortening of patients' lives. A shortened life span does not allow us to achieve the wisdom for which we especially value older people.

It's time save our parents, mothers from excessive “care” of medicine. But if you are tired of living and want to quickly get rid of life in the most “cultural” way, then don’t think twice. To paraphrase a line from a now famous song: “We have a place for old people everywhere...”.

Among the important and at the same time controversial problems of medical ethics is the issue of compulsory treatment, in particular, compulsory operations. It is known that in case of diseases that are dangerous to others, the patient undergoes mandatory treatment, for example, for sexually transmitted, mental, and infectious diseases. Compulsory treatment, even hospitalization, is not such a rare occurrence in the practice of venereologists or psychiatrists. Sometimes violence is inevitable. And then “the matter of medical ethics is the basis, the justification of this minimal violence, which in exceptional cases the doctor decides to do in relation to individual patients.” This formulation of the question is humane both in relation to society and in relation to the individual.

Another question is more complex: what to do in cases where the disease does not pose a danger to society, but the patient or his relatives, for one reason or another, refuse the necessary treatment methods, for example, surgery, and even give a receipt for this? Will a doctor act humanely if, understanding the necessity of surgical intervention, he refuses it and follows the patient’s lead?

In domestic medicine, these issues have been discussed since the pre-October period. Views were expressed both against and in favor of forced operations. Doctors representing the first point of view referred as an argument to the principles of individual freedom, to their right to manage their health and life. Their opponents, on the contrary, emphasized the idea that the doctor is a spokesman for state interests and is therefore obliged to bear responsibility for the health of citizens and, when necessary, perform an operation without the formal consent of the patient. Professor Engelman wrote that “in cases where parents, guardians, and the patients themselves are ignorant or show criminal intent and therefore do not allow the operation to be performed, the doctor is obliged to perform it by force.”

In the Soviet state, the issue of forced operations found its legislative solution. According to the resolution of the Central Executive Committee and the Council of People's Commissars of December 1, 1924, all surgical operations are performed with the consent of the patients, and for persons under 16 years of age - with the consent of the parents. The resolution states that a doctor can perform an operation necessary for life-saving reasons without parental consent after consultation with other doctors, “if the parents cannot be interviewed. The attending physician consults with other doctors about the need for operations even if the patient is unconscious. However, if there is no time for a consultation due to the patient’s serious condition, then the doctor must decide on the operation independently.

The existence of such legal norms is useful: they are not just a formal tribute to individual freedom, but are also necessary in essence, since they protect the patient from the wrong actions of the doctor. However, it should be emphasized that the legal regulation of a surgeon’s actions does not exclude a number of moral problems from the scope of his professional activity. The fact is that the patient may incorrectly use his right and refuse a vital operation. A highly moral doctor will make every effort to convince the patient of the need for the operation indicated for him. S. V. Kisin’s book “The Doctor’s Profession is a Feat” gives a typical example in this regard. Mother N., due to health reasons, needed a cesarean section. She and her husband categorically refused. A variety of arguments and methods of persuasion were used, even to the point of promising to report this criminal persistence to her husband’s work. As a result, consent was obtained and the lives of the mother and child were saved. Our medical practice knows a huge number of similar examples. However, there are also doctors who are satisfied with a receipt from a patient who refuses treatment. The same book by S.V. Kissin talks about another, directly opposite fact from the work of a gynecological clinic. A pregnant woman with pronounced symptoms of nephropathy (kidney disease) was released from the clinic home with a signature. Subsequently, when the symptoms of late toxicosis increased, the patient was offered hospitalization a second time and was refused a second time. W. The women took the receipt again. The result is the death of a twenty-year-old woman.

Most often, the reasons for refusing surgery are the patient’s fear of the operation, fear for its outcome, lack of trust in the skill and integrity of the doctor, and often an inept or indifferent attitude towards the patient. Consider, for example, such a dialogue between a doctor and a 6th year medical student who is about to undergo heart surgery and who, naturally, is very alarmed about what is coming: “Doctor, tell me, should I decide to have this operation?” - And in response: “You are medically educated, your heart is up to you to decide.” A sensitive and attentive attitude towards the patient, the desire to encourage him, calm him down, convince him of the need for surgical intervention, holding consultations, etc. contribute to the establishment of such relationships when the patient completely trusts the doctor.

In surgical practice, there are many examples when patients refuse an operation that saves a life, but makes them disabled. In a moment of weakness, they declare their readiness to die rather than be disabled. Life, however, shows that such people subsequently often condemn their weakness and thank medical workers for saving their lives. Although it should be recognized that the problem is very complex and does not have a clear solution.

Sometimes the doctor lets the patient decide for himself: “Are you going to have surgery or will we take pills while we observe?” Thus, the unfortunate patient is burdened with the burden of a decision on which his immediate life depends. On the one hand, if there is a choice, then all is not lost. But sometimes wait-and-see conservative tactics can lead to such changes when no operation will help.

Don't miss the moment

If the doctor gives a choice, the patient will more often choose conservative treatment, because “surgery is scary.” But what is worse in the end is still a question.

A typical example is bleeding from a duodenal ulcer. The surgeon offers the patient to promptly sutured the ulcer, along with the bleeding vessel. The patient asks: “Doctor, can’t it be stopped without surgery?”

Well, the doctor honestly answers that it is possible. Indeed, such bleeding in many cases is treated conservatively, especially if the clinic is well equipped with endoscopic equipment. And here we have the first problem: if the clinic does not have expensive equipment (and in most district hospitals this is the case), then the endoscopist will at most find an ulcer and register bleeding. That's it, its function is completed. Such a diagnosis, as you understand, is imperfect: you can lose sight of serious factors that can influence the decision on the choice of treatment tactics.

But let’s say the equipment did not fail, the diagnosis was correct and the patient was placed in the intensive care unit for hemostatic therapy. Again, most often such therapy leads to success and the question of surgical intervention will not arise. But sometimes, despite treatment, the ulcer continues to bleed, a little, but constantly. With such continuous bleeding, changes occur in the blood coagulation system, which gradually exhausts its potential.

And then further conservative expectant therapy can lead to the fact that the blood stops clotting altogether. I have seen bleeding where a patient vomits a mouthful of pure, scarlet blood, filling a basin in a matter of minutes. With such bleeding, even surgery may be powerless, since any new (surgical) wounds will bleed.

In fact, the chance of stopping the bleeding before it becomes massive is quite high. But how can you predict whether it will stop or flow like a waterfall and at what point should you decide to operate? You can take additional tests, you can replenish coagulation by administering fresh frozen plasma, but no one can give guarantees.

It would seem that since drug treatment is unreliable, it means that it is definitely better to have surgery? Alas, the risk and surgical complications have not been canceled, and the patient is also honestly informed about this. At the same time, it’s also good if the hospital has a surgeon who is not afraid to trust with his body, but what if he is young and inexperienced?

But the risk of unsuccessful intervention and complications is not the only thing that frightens patients. For example, a common fear is waking up during surgery. Is this possible? Unfortunately, it is possible. However, now every hospital is equipped with monitors that monitor blood pressure, pulse, ECG, and some even monitor brain potentials, so the risk is minimized.

Another fear is not waking up. Yes, that happens too. However, medicine does not stand still. Anesthetics have become less allergenic and less harmful to the heart. Monitors constantly record all changes in the body, and any deviations from the norm are responded to with a bell. And breathing apparatuses are now so smart that they themselves adapt to the requirements necessary for a given patient.

And I respect those experienced surgeons who will approach a patient and say: “You know, Vasya, let’s not pull the cat by the tail - we need to operate.” He said it bluntly, and Vasily can only agree.

On the other hand, it happens that diseases of the heart and lungs dramatically complicate the task of surgical intervention. It looks like it needs to be cut, but will it survive? Then, more often than not, the patient is not touched and treated conservatively until the end.

In general, more depends on the patient than it seems at first glance. We, resuscitators, have long noticed that if a patient has a strong desire to live, climbs, and grabs every opportunity, he will survive! And if the patient has resigned himself, then in the vast majority of cases he will bend, and no efforts of doctors will help.

And decide to have surgery

Not long ago I was faced with a choice.

A formation was found in the lung, small, round, with clear edges. An experienced surgeon looked at the CT scan and gave me, trembling:
- Well, colleague, I can’t say exactly what’s there right now, you understand that yourself. The most accurate diagnoses are made by pathologists, but I will only say that this is most likely such and such a disease. But,” he exhaled, squeezing his eyes shut from the cigarette smoke, “we can remove this matter, or we can observe: if there is growth, we will operate, if there is no growth, we will not.” Live on - watch.
My condition is not difficult to imagine... And what do you think - what did I answer in the end?
- Doctor, just cut, get this crap off me, I don’t want to sit on a powder keg!
“That’s right,” he approved, “get tested, then we’ll go through the offices, then go under the knife.”

That's it, only surgery, only hardcore! They removed this nasty thing from me, I won’t write what it was, then I took chemo for six months. Yes, it was hard, yes, there was weakness and depression. But my family supported me, and now I live and enjoy life! The only things that remind me of the operation are the scar and the tantalum sutures in the lung tissue on the x-ray. And I think I made the right choice.

And I am surprised by people for whom surgery is vital, but they refuse. Why? At the same time, they occupy hospital beds hoping for something unknown.

Once a patient was admitted, barely alive from malnutrition, due to the fact that food did not pass through his esophagus, because earlier he had foolishly drunk vinegar essence and, as a result, the adhesive process had taken over the entire esophagus. When it became difficult to swallow solid food, he was offered bougienage (dilation of the esophagus with a metal olive that is forcibly passed through a tube) - he refused. We waited. Only the egg mixture and water began to pass through.

They suggested making a hole in my stomach and putting on a gastrostomy tube so I could feed through it, but I refused. What can the doctor do? Feed through a vein. But this is very expensive and difficult for the body itself. A better diet than normal borscht with meat has not yet been invented. The gastrointestinal tract is an ideal mechanism for selecting all the necessary nutrients; no intravenous feeding can replace it. Therefore, if you want to live, you need surgery. But he refuses, but he doesn’t want to die. But we cannot force it...

Understand that when there is no choice, you have to have surgery. If surgery can bring relief, what are you waiting for? There is an opportunity to remove the problem - remove it, there is an opportunity to cut and stretch the problem where it is needed - pull it, there is an opportunity to live - live! All that remains is to choose a surgeon.

Vladimir Shpinev

Photo thinkstockphotos.com

Therefore, if a patient refuses surgery, the doctor must work in two directions:

continue to persuade the patient and carry out conservative (usually very palliative) therapy. As a rule, an experienced psychologist, after a skillful conversation, still obtains the patient’s consent. In other cases, the most authoritative person for the patient should be invited (if time and conditions allow this). This could be a relative, a workmate, a trusted friend, a boss, a lover, and finally, a leader from the back alley. The doctor must first have a convincing, focused conversation with this person. Sometimes successfully operated roommates, previously instructed by the doctor, help to persuade the patient. In some cases, a consultation of serious, preferably older, doctors or an invited chief physician helps the patient make the right decision.
In parallel, the most vigorous conservative treatment of a patient who refuses surgery should be organized. You need to know what methods exist for conservative treatment of perforated gastric ulcer, acute intestinal obstruction, massive gastrointestinal and pulmonary bleeding, acute appendicitis, cholecystitis, pancreatitis, and still try to save the patient, despite his refusal to undergo surgery.

At the same time, if you still have hope that the patient may still agree to the operation, avoid immediately prescribing analgesics, as a result of which the patient will subjectively feel better, after which you have no chance at all of persuading him to undergo the operation in a timely manner. will remain.
One day I was urgently invited to the District Military Hospital to see a soldier with a perforated stomach ulcer, who refused to undergo surgery. A group of officers stood outside the chamber. He had already been persuaded by the head of the department, the chief of medicine, the head of the hospital, the commander of the unit and even the general - the head of the garrison, but completely unsuccessfully. To the general’s order to undergo an operation, the soldier reasonably replied that, according to your order, I can die in battle, but not on the operating table. I don’t know what is written about this in the regulations of the internal service of the Soviet army, but still, after this conversation, the soldier was not forcibly dragged into the operating room.
Examination of the patient completely convinced me of the correctness of the diagnosis and the need for emergency surgery. However, I was not able to persuade the patient to undergo the operation, although I, as a last argument, threatened him that without the operation he would definitely die. Everything was useless.
Then we inserted a probe into the patient’s stomach, with the help of which we carried out constant aspiration of gastric contents, and prescribed antibiotics and drugs directed against non-clostridial anaerobic infection. The patient recovered and when I showed up at the hospital two weeks later on another matter, he met me in the corridor. Showing me to his interlocutors, he spoke very unflatteringly about the professors who claimed that without surgery he would definitely die, but he, thank God, turned out to be smarter, and therefore alive and well.
And one last thing. If the advisability of the patient’s signature in the medical history regarding consent to the operation can still be discussed, then the patient’s personal signature if he refuses the proposed operation is absolutely mandatory. It is desirable that the refusal of patients be justified. Perhaps all measures taken by the doctor to obtain the patient’s consent should be recorded in the medical history.
However, if in emergency situations someone has doubts about the doctor’s right to control the fate of the patient, then in relation to the planned patient there is complete unanimity. No one will perform an operation without the patient’s consent.
It is not uncommon for a patient admitted to the hospital for surgery to suddenly refuse it. It seems that the direct responsibility of the doctor will be to persuade the patient to undergo surgery. This is the simplest, but not always the right solution. Sometimes a doctor, having received a refusal to all entreaties, falls into ambition and presents the patient with a strict alternative: either surgery or home. In cases where the only treatment option is surgical intervention, he is, of course, right. But in some cases, conservative treatment, albeit palliative, is still possible. Nevertheless, this patient is discharged because beds are needed for patients who will undergo surgery, or simply out of ambition, into which the doctor, irritated by the patient’s refusal, falls.
When I worked at the Veterans Administration Hospital in San Francisco, I was initially amazed at the completely unusual patient-doctor relationship. Already during the first meeting at an outpatient appointment in the department of vascular surgery, it seems that good friends are meeting. The surgeon, for example, takes his time, explains in some detail to the patient and his wife or other close relative, who is usually present at the reception, the full complexity of the problem and offers surgical treatment. The patient either immediately agrees, or puts forward counter-arguments, or asks for a short delay in order to discuss the doctor’s proposal with the family. The doctor expresses his thoughts and after a friendly discussion, in which the relative present also participates, a joint decision is made. At the same time, the doctor does not put harsh pressure on the patient and seriously takes into account all the family, social and psychological circumstances of the patient.
I can't help but add some small but important touches here. The office is clean and most importantly, comfortable. Nice, simple furniture, inexpensive paintings, flowers. A wide paper roll is attached on an axis to the head end of the couch, on which the patient is laid. The nurse rolls out part of the roll and the patient lies down on clean paper. If the doctor leaves the office during the appointment, then before entering again, he will definitely knock and enter only after receiving the patient’s permission.
A patient’s refusal to undergo surgery is often due to the fact that he is poorly or insufficiently informed about his diagnosis and the therapy being carried out. As you know, obedience presupposes trusting command. It follows that the doctor must have certain leadership qualities. He must be able (and therefore trained to do so) to persuade the patient to approve of all his actions necessary for an accurate diagnosis and successful treatment.

Any citizen can write a refusal to undergo an operation if it does not lead to fatal consequences, especially when it comes to a child. Adults must understand the entire situation - the complications, consequences and rights that come with such a refusal of medical intervention. Of course, if the doctor seemed (subjective factor) inexperienced, the patient can go to another doctor. But is it worth writing a preliminary refusal when, for medical reasons, this is an urgent measure to save a person.

In order for an operation to be prescribed for a specific person, its organization and planned preparation require significant or relative indications. Good reasons are a threat to life and health, relative reasons are when “time” is waiting. But in no case can a person be forced to take such a step. There is an unspoken rule when doctors prohibit themselves from performing operations, since this differs from their “purpose” and medical ethics. The physician who refused to intervene does not agree to the consequences. Anyone who agrees to them admits his inability to heal people.

As for patients, these are isolated cases when the reason for refusal is fear or fear of dying prematurely. There are many such cases, but doctors cannot help but mention the need for surgical treatment. The decision remains with the patient, and referring to Federal Law No. 323, every person has the right to refuse surgical intervention without justification.

This cannot be done if we are talking about urgent measures to save the lives of adults and children:

1. Emergency indications for urgent surgical intervention. It happens that in a matter of minutes it is necessary to remove fragments and foreign objects, which by their presence interfere and complicate a person’s life and chance of survival. Refusal is regarded as suicide, so doctors, most often, despite any threats, act as required by ethics and job responsibilities.
2. Emergency operations are unplanned. This even applies to children, when it is believed that temporarily delaying operations could cause harm to health or lead to death.
3. Planned operations in the field of oncology. Children and adults who have received quotas cannot refuse the operation, only transfer it or assign it to another clinic. This is a kind of deal with life, when it is impossible to give up the right to life and further recovery. Any doctor would do the right thing if he forced a patient to undergo a planned operation. This means that even while being treated in a hospital, there is no result, the dynamics are bad or worsening. The only salvation is intervention, especially in the case of cancer - this is not a guarantee, but an attempt to survive.

If the operation is obtained under a quota, as in most cases, it cannot be refused in principle, because this right is taken away from other patients who need to save their lives. By being careless about his health, the patient exposes other people to temporary expectations, which is not legal. But if the patient was unable to appear on time for examination before the operation itself, he asks to postpone it or shift it by several days, then a refusal is filled out with a subsequent request to increase the timing of the preoperative intervention.

In order to receive a quota again, the patient will have to prove the need for treatment, because if the refusal was once, it may happen again. And these are long months of waiting, while other children and adults simply cannot wait.

Many people who believe in prejudices believe that refusing surgery in a hospital or being admitted to a medical facility is a malicious violation. Although some, due to their faith confession, consider this a lawful act. According to Article 33 of the Federal Law “On the Health of Citizens” of the Russian Federation, every person or his representative has the right to disagree with such manipulations. The only thing that is required is the consent of the police and guardianship authorities, if we are talking about a child whose right to life is decided by the parents.

Of course, they are responsible for it, but they cannot accurately predict whether there will be complications after surgery or will appear if it is abandoned. In practice, there are many cases when parents and relatives of incapacitated people agreed to an operation, after which the person died. Many blame the doctors, however, they tried their luck and gave a chance that can be taken advantage of. On the other hand, if another doctor had administered anesthesia, anesthesia, or something else, the person could have survived.

There is a case from medical practice when the parents of a little girl came to the clinic. The mother complained of severe swelling in the neck area, as a result of which, after examination and diagnosis, and interviewing the parents, it was determined that their daughter had intoxication. The child ate the pills, thinking they were candies. Overdose. Gastric lavage did not help, as the drugs entered the blood. Hospitalization is required, which the parents agreed to, but they did not give the right to perform the operation. They referred to the fact that “everything is God’s will, if the Lord decided so, then this is the daughter’s fate.” The College of Doctors immediately called the police. The question arose about depriving the rights of religious parents, since traces of blows were also found on the child’s body (the result of initiation into a sect).

The guardianship authorities demanded an explanation, and the police allowed the operation, citing the expert assessment of the researcher in the field of forensic medicine. If the girl had not undergone intervention, she would have died on the second day.

Therefore, it is worth understanding that replacing concepts and replacing laws is not a solution. Rights to treatment cannot be established by parents who, a priori, would not save the child’s life.

When wondering whether I have rights to refuse surgery, I need to think from two angles:

1. What are the health consequences after refusal, and is it worth writing a will right away?
2. And what complications may arise if you agree to the intervention.

If in one case there are fewer side effects, then it is better to give preference to this type of solution. The medical record will reflect everything, right down to the condition at the time of the start of the surgical intervention. To complete the map, experts and doctors from other clinics may be invited. Thus, indicator data are written for various initial situations. It is worth noting that if a person is sick with an infectious disease, then he cannot even refuse treatment, not for the sake of his own salvation, but for the sake of not infecting the people around him, because they will become infected.

This was said in children's intensive care wards, when in one sector there are children suffering from scarlet fever and chickenpox. If a child with poisoning leaves the ward into the corridor and gets sick, the head and pediatrician will be guilty, as well as the parents of the infected child who are in the ward with him, for the fact that the healthy baby got sick. At the same time, treatment does not stop, no one is released from the hospital. On the contrary, cancellation will indicate reluctance in recovery.

For a lawful refusal, when it will not complicate anyone’s life, you can and should draw up an application. If you do not know how to write a waiver of surgical intervention, draw up a rough plan with the head of the department. Further, the information is supplemented “on my own”, since a personal desire is expressed in this, and not under the dictation of a physician.

There is a form on which the patient must write the reasons for refusal.

1. First you should think about whether the health problem will be solved, or whether consequences will still appear.
2. Will there be complications if you agree to undergo surgery, and what are they? The doctor will tell you about this; however, in special cases, it is in his interests to persuade the patient to give consent.

If hospitalization was carried out due to emergency measures, you still need to write consent or refusal. This does not apply to the birth of a child by cesarean section, acute pain in the appendicitis area, hernia or chronic symptoms in the form of tightness and compression. If the indicators are normal or relatively “tolerable”, the patient will be freely released after writing a refusal. If the hospital has everything necessary to perform an emergency operation, the refusal will be signed only after a meeting of the board of doctors.

For example, emergency removal of the gallbladder or its partial deformation, which led to the release of bile into the stomach cavity. The time is counted in seconds, so a refusal can be issued later if the operation is postponed due to improved medical conditions.

For clarity, below is a sample application that may be accepted for consideration. However, in such conditions there is no alternative treatment available, and the transfer or discharge of the patient is envisaged.

During diagnostic measures, it was determined that urgent surgery was needed to remove the cyst in the ovarian area (another location). I, __________ (full name) refuse surgical intervention, because I wish to receive an alternative non-anesthesia method (laser) for dissecting the cyst. This medical institution does not perform such an intervention, so I would like to contact ____________ (address of another institution), where they will perform this type of surgery with my consent.

I, ___________, understand that refusal entails complications if the problem and treatment of this ailment are not addressed in time. I am of sound mind, I understand the doctor’s explanations about the possible consequences, however, I do not want to agree to the proposed type of operation.

Signature ____________

Date _____________.

In other cases, when the operation is “tolerable,” it can be performed immediately in those clinics where there is equipment and qualified personnel.

Unfortunately, many public hospitals do not perform complex interventions, since the ends and means do not justify themselves, and patients often “leave”, and relatives cannot come to terms with the loss, since there is neither a medical error nor confirmation of a lack of experience. In this regard, many are interested in how to formalize a refusal of surgery in a hospital institution, because there is no other way to save life: a complication and life, or the right to health with a fatal outcome.

A sensitive question that interests not only soldiers, but also conscripts who want to “escape” responsibility to their homeland is whether it is possible to refuse an operation at the military registration and enlistment office? If there are serious illnesses, a conscript has the right to refuse medical intervention necessary to restore his ability and conscription. This can be interpreted as the mercantile side of a military institution, which even wants to carry out an operation for free, if only a person would join the army. But many fear that harm will be caused not only to health if they agree to the intervention, but also to their reputation or future life if they refuse it.

There are cases when a conscript with varicocele is forced to serve. Yes, at the first stage, when the drainage veins in the area of ​​the intimate organs are dilated, the person is fit for service. If the degree of development of the disease is different, then this is a ban on holding this position. And until the treatment is completed, the man does not join the army. If this situation lasts for several years, is the person obligated to agree to the operation at all, or is it his right? But the question immediately arises: he has a duty to his homeland, but will not fulfill it because of his own refusal to eliminate the reasons.

In such cases, a deferment is taken:

1. Or the serviceman wants to serve and does everything for this.
2. Or a man receives the “stamp” of being unfit for the army, and then lives without a military ID, roughly speaking.

If it is decided that a refusal will be drawn up, an example of the appeal is presented below:

To the chairman of the draft committee ____________

Address_________

Commissariat No. _____________

Head of department for the district ____________

To the doctor in charge of examining citizens ___________

Military registration and enlistment office address ___________

Full name _______________ (application party).

Declaration of illness and refusal of surgical intervention:

I inform you that I, __________, have diseases ___________ (specify), the diagnoses of which have been confirmed, and documents and extracts are attached to this application. In exercising the right to refuse medical surgical intervention on the basis of Art. 30-33 Federal Law No. 123 on “military medical examination”, I refuse treatment.

I ask you to examine me on the basis of Art. 45 in the list of illnesses, assign me category of fitness for military service “B”, limited fit.

1. Attach this document to the recruiter's application.
2. Consider the document a real refusal of surgical intervention.
3. Based on paragraphs. And clause 1 of Art. 23 Federal Law No. 28, exempt me from military service.

I also ask you to issue a copy of the decision of the draft commission in accordance with Federal Law No. 28 on accepting an immediate refusal.

The application is filled out and registered in the office.

Thus, even in the presence of serious illnesses, a person has the right to refuse treatment, which involves intervention in a conservative way. If this saves his life, which no one can know in advance, then the patient and citizen of the Russian Federation as a single person have the right to obtain permission to implement their constitutional provisions.