Doctor, I don't want the drugs: Can we talk alternatives?

In my medical practice of over 25 years, I have often encountered patients who unequivocally decline medication as part of their treatment.

This happens in cases involving both physical and mental health conditions. But is it simply a refusal, or a plea for alternative approaches free from medication side effects, or perhaps an attempt to avoid assuming the “patient role”?

In psychiatry, such decisions are even more complex. They are often influenced by stigma, myths, and misconceptions about mental illness, as well as struggles involving faith, culture, and personal autonomy.

However, treatment isn’t always found in medication. It can come through talk therapy, lifestyle changes, community support, spirituality, or a combination of these approaches.

Sometimes a patient argues, “If I give it time, it will go away.” But does the patient fully understand their diagnosis? Do they realise how their medical history, risk factors, family background, test results, or medical imaging might influence the doctor’s decision?

Treatment doubts

In other cases, a patient may have heard about a medication’s side effects. Some do not want to endure the treatment, while others simply do not believe they need it. There may be concerns about possible complications or a belief that alternative treatments are more effective or safer.

There are ethical considerations when a patient declines treatment. For example, has the patient received all the necessary information about the benefits of the proposed treatment and the risks of refusing it? Patients have the right to seek a second opinion or even refuse treatment, unless such refusal poses a danger to others or the patient is mentally incapacitated and unable to make informed decisions.

Mentally competent adults have the right to refuse any treatment, even if doing so could lead to serious illness or death. Doctors must, therefore, balance treatment recommendations between improving quality of life and extending life, especially in cases involving chronic conditions.

A mentally competent adult who is not a risk to others or a minor can also prepare advance directives about how their care should be handled if they lose the capacity to make decisions. This may include wills, durable powers of attorney, Do Not Resuscitate (DNR) orders, or physician orders for life-sustaining treatment.

Can a doctor also refuse to prescribe medication? Yes. If laws and regulations in the doctor’s jurisdiction prohibit a particular prescription, or if clinical judgement and patient safety are at stake, the doctor can decline. If there is potential for misuse or abuse, or no medical necessity for the requested medication, a doctor is ethically and legally allowed to say no. In some cases, prescribing a medication may even constitute malpractice—especially when drug interactions or associated health risks are involved.

Dr Mutisya is a consultant psychiatrist