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Ethical Challenge in Nursing: Medication Non-compliant in Patients with Schizophrenia One of the most difficult ethical challenges I have faced in nursing is medication non-adherence in patients with schizophrenia, particularly when a patient refuses treatment despite clear evidence that it benefits them. This issue puts nurses in a challenging position to balance patients’ autonomy with the ethical responsibility to ensure their well-being. Why I Chose This Ethical Challenge and Its Importance I have worked with many patients with schizophrenia who refuse to take their medications for various reasons and nurses often struggle with whether to respect their autonomy or intervene more assertively to prevent relapse and potential harm. This challenge is important because it affects patient safety, hospital readmission rates, and overall treatment success. It also raises difficult questions like ‘Should a patient with a history of severe psychotic episodes be forced to take medication? When does a patient’s right to refuse treatment outweigh their need for medical care? Specific Situation I Experienced I once cared for a 25-year-old man diagnosed with schizophrenia who was a rapid cycler and had a history of repeated hospitalizations due to medication non-compliance. He had a history of refusing oral medication and was switched to long-acting injectable (LAI) antipsychotics after one of his hospitalizations. He was stabilized on the LAI antipsychotics during his inpatient stay, but after being discharged, he stopped attending his follow-up appointments and refused his medication. A few weeks later, he became increasingly paranoid, almost hurt his housemate, and was brought back to the hospital by his caregiver after an incident at his local Walmart that warranted calling 911. Despite his worsening condition, he refused to restart his medication, claiming he did not need it. His family was desperate for help, fearing he would relapse further and become a danger to himself or others. How It Was Addressed The patients’ healthcare team including psychiatrists, nurses, and social workers, met to discuss possible interventions. He was put on a temporary involuntary 72 hour hold for psychiatric evaluation to try and stabilize him, which was not the first time. The nursing team advocated for a patient-centered approach, prioritizing education, and engagement. I spent time educating the patient and his family about the benefits of LAIs versus oral medication, explaining how LAIs could improve adherence and reduce relapse risk. The patient was still reluctant but agreed to a trial of LAI. He was given the first shot and discharged after 5 days and refused the second shot that was due 8 days after, before the monthly shot. He was back in the hospital within a month. His mental state continued to decline, and he refused oral medication or LAI despite multiple discussions. The ethical dilemma here is Involuntary Treatment vs. Autonomy. The law cannot force anyone to take their medication, even if it is court-ordered. This has been the cycle for this patient for more than 3 years. We stabilize him at the hospital and send him home, where he refuses his medication and comes right back on admission.

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