Wards Simulation Platform

How This Works

This is an interactive phone call simulation. You'll speak with Frank in a realistic clinical communication scenario.

1. Start Call

Click "Start Call" when you're ready. Speak naturally as you would on a real call.

2. Have the Conversation

10 minutes to complete the call. The AI responds in real-time to what you say.

3. Get Feedback

End the call when finished. You'll receive AI-powered feedback on your communication.

💡 Tip: Speak clearly and at a natural pace. If you need a moment to think, it's okay to pause briefly - just as you would in a real conversation.

Briefing Details

1. Learning: Honoring Patient Autonomy

Purpose of this Scenario

A competent patient's right to refuse medical treatment is a cornerstone of medical ethics, even if that decision may lead to their death. This conversation is not about convincing the patient to accept treatment, but about ensuring their decision is informed, voluntary, and not the result of a treatable condition like depression. The goal is to explore the 'why' behind their refusal and, if the decision is firm, to honor it by transitioning to a plan focused on comfort and dignity.

Key skills include:

Assessing decision-making capacity.
Using open-ended questions to explore the patient's reasoning and values.
Differentiating between a reasoned choice and a cry for help.
Clearly explaining the consequences of their refusal.
Affirming your commitment to their comfort, regardless of their choice.

2. Scenario Briefing: The Patient Who "Wants to Stop"

Your Objective

You are the hospital physician. Your objective is to have a conversation with Frank, a 72-year-old man with end-stage COPD, who is refusing to wear his BiPAP machine despite being in respiratory distress. You must assess his capacity, explore the reasons for his refusal, ensure he understands the consequences, and ultimately be prepared to honor his wishes.

Patient Background

Frank is a 72-year-old man with a long history of severe COPD. This is his third hospitalization this year for an exacerbation. He is currently in respiratory distress, but is alert, oriented, and has full decision-making capacity.

Crucial Information: The nurse has just informed you that Frank is refusing to wear the BiPAP machine. He knows that this has helped him get better during past admissions. He is simply saying, "I'm done. No more machines."

Key Medical Facts

Diagnosis: Acute-on-chronic hypoxic respiratory failure from a COPD exacerbation.
Proposed Treatment: Non-invasive positive pressure ventilation (BiPAP) to support his breathing while steroids and antibiotics treat the exacerbation.
Patient's Choice: He is refusing BiPAP.
Consequence of Refusal: Without ventilatory support, his respiratory muscles will tire, he will retain CO2, become progressively sleepier (hypercapnic narcosis), and likely die within hours to days.

Learning Objectives

Optional prep details

After completing this scenario, you will be able to:

Assess a patient's capacity to refuse life-sustaining treatment, ensuring their decision is informed and voluntary.
Apply ethical principles of patient autonomy in a goals-of-care discussion with a patient refusing treatment.
Differentiate between a capacitant patient's autonomous refusal of treatment and a refusal influenced by reversible factors like depression or uncontrolled symptoms.

Optional Pre-Call Knowledge Check

Optional self-check before you start

A competent patient with a terminal illness refuses a potentially life-prolonging treatment. What is the most ethically appropriate initial action for the clinician?

When a patient with end-stage COPD expresses a wish to refuse further treatment, which of the following is most important to screen for as a potential reversible cause for their decision?

Which of the following is NOT a required element for determining a patient has the capacity to make a medical decision?

Goals of Care: Patient Refusal of Treatment