Ask D"Mine: The Right to Refuse, and Choosing Medications

http://type2diabetestreatment.net/diabetes-mellitus/ask-dmine-the-right-to-refuse-and-choosing-medications/

Hey, All -- if you"ve got questions about life with diabetes, then you"ve come to the right place! That would be our weekly diabetes advice column, Ask D"Mine, hosted by veteran type 1, diabetes author and clinical specialist Wil Dubois.

Today, Wil tackles a tricky question about navigating care choices for those we love in assisted living facilities. This is a key issue for our own Mike Hoskins, who has a family member who just moved into a new senior community -- where the daily medicine regime is a big factor. Wil also chimes in on the importance of choosing particular types of insulin that might work best for some, but not all.

Read on...

Got your own questions? Email us at AskDMine@diabetesmine.com

Peggy, type 1 from Massachusetts, asks: Can a person in a nursing home refuse to take medication such as insulin?

Wil@Ask D’Mine answers: Absolutely! No one can force you, or anyone else, to take a diabetes medication. It’s your choice. Even if NOT taking insulin would result in your death.

Now, that being said, some interesting things might happen to the refusee. First, the person refusing would likely be asked to sign a form called an AMA. That stands for Against Medical Advice. Basically it’s a form that says something like, “My very smart doctors have told me that ignoring their sage advice may result in my coming to harm, but I’m being an idiot and ignoring them anyway, and if something bad happens to me I won’t sue them.”

Next, the nursing home might be able to discharge the refusee, although that would depend on a lot of factors, such as the state they are operating in, and how many lawyers are on the management team. It sounds like a big stick, “take this med or you’re out on the street,” but in fairness to the nursing home, having people opt for passive suicide rather than live in their facility is bad for business. Of course, if the nursing home takes Medicare or Medicaid funds, they are bound by federal 1987 Nursing Home Reform Act, which among a ton of other things, specifically spells out the right to refuse medication.

Your fundamental right to refuse medical treatment, either in or out of a nursing home, isn’t limited to medications, either. Every day people opt not to have surgical procedures for heart disease, or even cancer. They weigh the cost/benefit odds and make choices that make sense to them, even when their doctors disagree. Sometimes this works out for the patient.

Sometimes it does not.

But insulin is life or death, right? Well certainly for type 1s it is, with a pretty quick exit once refused. And it would likely be for a type 2 who required it, too. It would just take longer. But there are plenty of other examples in which refusing medical treatment is certain to cause death and is still allowed. Refusing dialysis is one that comes to mind. Plenty of people do that, and it’s fully legal. You can’t be forced to take dialysis against your will.

Even with “guaranteed” fatal outcomes from refusal, the right of refusal is a cornerstone of our system of medicine.

Oh. Wait.

There is one circumstance in which you can be forced to take insulin. So forget everything I just said. Well, not everything. Just the part about “no one can force you,” because, like everything else in life, there is an exception.

You can’t refuse medication if you’ve been judged mentally incompetent. Then, sadly, it’s no longer up to you. It’s up to your legally appointed guardian.

But so as long as you are mentally competent—or at least haven’t been judged mentally incompetent—the nursing home staff cannot strap you down and inject you with insulin.

You can choose to refuse.

Joanne, type 2 from Kansas, writes: I have just started having to give myself insulin shots. The needles are not the issue for me; the issue is the reaction I get from the shot at the shot site. I tried to do it in the belly but I get the worst reaction. I get a very large red blotch at the injection site that is a lump and it hurts terribly for about 4 days and then in about a week it goes down but a mark still remains. I tried to give it in the arm and the same thing happens but not to the extent of the stomach. This is also true in the thigh. The thigh seems to be the lesser of the evils. What do you think the issue is? Is it an allergic reaction to the needle? It is frustrating because the insulin is really helping with my sugar levels, but I find it is becoming an issue to the point where I cant wear anything around my stomach because it aggravates it more.

Wil@Ask D’Mine answers: It seems it"s not the needle you are allergic to; it’s the brand of insulin. While insulin itself is pretty universal, as a molecule, the fluid that the molecule is suspended in varies from maker to maker. You can think of insulin as Kool-Aid powder, which could be mixed in distilled water, tap water, or Perrier.

OK, I confess. Kool-Aid was a bad choice for an analogy, given we are talking about diabetes, but you get the idea.

You’re not allergic to the Kool-Aid, or the Kool-Aid pitcher. You’re allergic to the Perrier.

Well, that assumes you’re changing your needle regularly. Heavy re-use of a needle can cause the skin to get irritated. These modern insulin needles are pretty spiffy, but they are also delicate and wear out quickly. If you over-use them, you might as well be stuffing rusty nails into your skin.

But so long as the needles are fresh and you’re still getting the reaction, the fix is simple. Ask your doc to change you to another brand of insulin. If the insurance company balks, not to worry. You are having a legitimate (and more common than generally publicized) medication reaction, and the insurance company is legally obligated to provide you with a medicine that does not make you sicker.

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn"t adhere to Healthline"s editorial guidelines. For more information about Healthline"s partnership with Diabetes Mine, please click here.

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