Arizona Bioethics Network

Wednesday, July 15th, 2026 – 4:00 PM (Arizona)

Mixed Signals: The Ethics of Caring for Patients Who “Refuse” in the Moment

Anna D. Goff, PhD, HEC-C
Assistant Professor of Medical Ethics in Clinical Medicine

This webinar will discuss, “Respect for autonomy is a guiding principle in Western medicine.” Simply put, so long as a patient is able to demonstrate decisional capacity, they have the right to accept (or refuse) recommended treatment. However, decision-making for critically ill patients is not always so straight forward; survival tends to necessitate a basic tolerance of treatment that is not necessarily guaranteed for all individuals. Some patients may want to survive and even consent to treatment yet say no in-the-moment or otherwise attempt to delay or avoid it for a range of reasons, including trauma response, anticipatory anxiety, pain, desire for control, or ambivalence, among other things. This webinar will feature a particularly challenging case of a burn patient who repeatedly expressed their desire to survive yet demonstrated extraordinary distress in response to care. We will explore the ethics of caring for patients such as this one, taking into consideration the shortcomings of existing conceptions of decisional capacity, the need for innovative, patient-centered solutions, and the distress that can result from navigating mixed signals in real time.

Participants will be able to:

1. Identify situations in which patients demonstrate conflicting preferences regarding treatment.
2. Understand the benefits and shortcomings of existing strategies for navigating patient refusals.
3. Consider ways in which providers can deliver patient-centered care under these challenging circumstances.

Anna D. Goff, PhD, HEC-C will be joining the faculty at Weill Cornell Medicine in July 2026 as an Assistant Professor of Medical Ethics in Clinical Medicine upon completion of her clinical ethics fellowship. She holds a PhD in Bioethics from Case Western Reserve University, and her research interests include ethical issues in the care of burn patients as well as the emotional experiences of clinical ethicists.

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