If you find yourself in a situation where you feel you may have to withdraw care you should consider your rationale for taking such action very carefully.
If you are considering withdrawing care because of inadequate or inappropriate PPE due to the current pandemic, please see our COVID-19 refusal to treat publication.
The following situations may justify a refusal to treat, the withdrawal of care or the finding of an alternative:
- where there exists, or there is fear of, physical violence
- where there is discriminatory behaviour
- where there are health and safety hazards e.g. lack of appropriate equipment
- where the care required is outside the scope of competence or training (another practitioner should be identified who does have the necessary skills and training sought - see below)
- where there is a conscientious objection
- where the client/patient is known to you in a personal capacity
- where you are asked to do something unlawful or in breach of the Nursing and Midwifery Council (NMC) Code.
Before you refuse care you should:
- consult with your manager and make your concerns known verbally and in writing as soon as possible
- follow the agreed protocols and policy for your place of work and familiarise yourself with your local safeguarding policies where necessary
- if you are a nurse, nursing associate or midwife, consider the NMC Code, the NMC's 'Standards for competence for midwives' (where applicable) and your duty of care
- if you are not a registered practitioner you must nevertheless consider your individual accountability for your actions. For further information on accountability please see the health care assistants (HCAs) and assistant practitioners (APs) section of our website
- consider the need for a risk assessment when taking these decisions. As always, the need to ensure safe systems of working is critical to patient wellbeing
- keep a copy of all documentation and keep a record of dates of any meetings/discussions
- consult with the patient/client and (if appropriate) their family
- make an accurate record of the decision to refuse to treat, to include the reasons for the decision so that you are able to justify your actions later if care is withdrawn.