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Patients have a right to refuse medical treatment. But what should happen after a patient has refused recommended treatment? In many cases, patients receive alternative forms of treatment. These forms of care may be less cost-effective. Does respect for autonomy extend to providing these alternatives? How for does justice constrain autonomy? I begin by providing three arguments that such alternatives should not be offered to those who refuse treatment. I argue that the best argument which refusers can appeal to is based on the egalitarian principle of equality of outcome. However, this principle does not ultimately support a right to less cost-effective alternatives. I focus on Jehovah's Witnesses refusing blood and requesting alternative treatments. However, the point applies to many patients who refuse cost-effective medical care.

Original publication




Journal article


J Med Ethics

Publication Date





231 - 236


Health Care and Public Health, Professional Patient Relationship, Religious Approach, Australia, Blood Transfusion, Christianity, Complementary Therapies, Cost-Benefit Analysis, Erythropoietin, Ethical Theory, Ethics, Medical, Health Care Costs, Humans, Jehovah's Witnesses, Patient Advocacy, Patient Selection, Personal Autonomy, Resource Allocation, Social Justice, Social Values, Treatment Outcome, Treatment Refusal