{"id":722093,"date":"2026-06-25T19:59:28","date_gmt":"2026-06-25T17:59:28","guid":{"rendered":"https:\/\/www.dynseo.com\/refus-de-soins-comprendre-et-agir-guide-pour-les-familles-et-soignants-dynseo-2\/"},"modified":"2026-06-25T20:03:00","modified_gmt":"2026-06-25T18:03:00","slug":"refusal-of-care-understanding-and-acting-guide-for-families-and-caregivers-dynseo","status":"publish","type":"post","link":"https:\/\/www.dynseo.com\/en\/refusal-of-care-understanding-and-acting-guide-for-families-and-caregivers-dynseo\/","title":{"rendered":"Refusal of Care: Understanding and Acting &#8211; Guide for Families and Caregivers &#8211; DYNSEO"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; admin_label=&#8221;Article HTML&#8221; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;0px||0px||false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row admin_label=&#8221;Contenu&#8221; _builder_version=&#8221;4.16&#8243; width=&#8221;100%&#8221; 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{font-size:14px;font-weight:700;color:var(--blue);margin-bottom:9px}\n.dbi-art-61bc1a .fi p {font-size:14px;margin:0}\n.dbi-art-61bc1a footer {background:linear-gradient(135deg,var(--blue),var(--blue-dark));color:#fff;padding:32px 20px;text-align:center}\n.dbi-art-61bc1a footer p {color:rgba(255,255,255,.8);font-size:13px;margin-bottom:12px}\n.dbi-art-61bc1a .fl {display:flex;justify-content:center;gap:10px;flex-wrap:wrap}\n.dbi-art-61bc1a .fl a {color:#fff;text-decoration:none;font-size:12px;font-weight:600;padding:6px 14px;border:1px solid rgba(255,255,255,.3);border-radius:50px}\n@media(max-width:560px) {\n.dbi-art-61bc1a .cards {grid-template-columns:1fr}\n}\n.dbi-art-61bc1a .banner {background:linear-gradient(135deg,var(--pink),#c0204e);padding:22px 20px;text-align:center}\n.dbi-art-61bc1a .banner p {color:#fff;font-size:14px;margin:0 0 12px}\n.dbi-art-61bc1a .bws {display:inline-block;background:#fff;color:var(--pink);font-family:'Montserrat',sans-serif;font-weight:700;font-size:13px;padding:9px 22px;border-radius:50px;text-decoration:none}<\/p>\n<\/style>\n<div class=\"dbi-art-61bc1a\">\n<header class=\"hero\">\n<div class=\"hero-tag\">\ud83e\udd1d Refusal of care \u00b7 Ethics \u00b7 Behavioral disorders \u00b7 Caregivers<\/div>\n<h1>Refusal of care: understanding and acting \u2014<!\u2013- [et_pb_br_holder] -\u2013>guide for families and caregivers<\/h1>\n<pee class=\"hero-sub\">Understand the mechanisms of refusal of care in elderly or vulnerable people, adopt a gentle and ethical approach, and find solutions that respect both the dignity of the person and safety requirements<\/pee>\n<\/header>\n<div class=\"banner\">\n  <pee>\ud83c\udf93 Qualiopi certified training \u00b7 Online \u00b7 At your own pace<\/pee>\n  <a href=\"https:\/\/www.dynseo.com\/en\/courses\/refusal-of-care-understanding-negotiating-and-respecting-a-gentle-and-ethical-approach-en\/\" class=\"bws\">Access the training: Refusal of care \u2014 gentle and ethical approach \u2192<\/a>\n<\/div>\n<p><main class=\"container\"><\/p>\n<div class=\"intro\"><pee>Your loved one refuses to take their medication. Your resident pushes back against any attempt at bathing. The person you are accompanying says &#8220;no&#8221; to every proposed care. Refusal of care is one of the most frequent and destabilizing challenges in geriatrics, palliative care, and disability support. It puts two fundamental values in tension: respect for the person&#8217;s autonomy and the duty of protective care. This guide gives you the keys to navigate this tension with humanity and effectiveness.<\/pee><\/div>\n<h2>1. Refusal of care: understand before acting<\/h2>\n<div class=\"hl\">\n<h4>\u2696\ufe0f The ethical and legal framework<\/h4>\n<pee>In France, the right to refuse care is fundamental: any adult and capable person has the right to refuse any medical or care act, even if this refusal endangers their life (law of March 4, 2002). This right also applies to people under guardianship or curatorship \u2014 the guardian cannot accept care on behalf of the person without their consent, except in urgent medical exceptions. The caregiver is not exempt from their obligation to inform and propose care \u2014 but they cannot impose it.<\/pee>\n  <\/div>\n<h3>1.1 The causes of refusal of care: behavior that always has meaning<\/h3>\n<div class=\"causes-refus\">\n<div class=\"cr\">\n<h5>\ud83d\ude23 Pain or discomfort<\/h5>\n<pee>The care is associated with past or anticipated physical pain. Often underestimated.<\/pee><span class=\"cr-approche\">\u2192 Systematic pain assessment<\/span><\/div>\n<div class=\"cr\">\n<h5>\ud83d\ude28 Anxiety and fear<\/h5>\n<pee>Fear of what will happen, of losing control, of the unknown. Common in dementia.<\/pee><span class=\"cr-approche\">\u2192 Preparation, explanation, reassurance<\/span><\/div>\n<div class=\"cr\">\n<h5>\ud83d\udd12 Cognitive disorder<\/h5>\n<pee>The person does not understand what is being proposed. Disorientation, distrust, confusion.<\/pee><span class=\"cr-approche\">\u2192 Adapted communication, routine<\/span><\/div>\n<div class=\"cr\">\n<h5>\ud83d\udeab Expression of autonomy<\/h5>\n<pee>The refusal is a way of saying &#8220;I still exist, I have the right to decide.&#8221; Especially in institutions.<\/pee><span class=\"cr-approche\">\u2192 Offer choices, respect agency<\/span><\/div>\n<div class=\"cr\">\n<h5>\ud83d\ude2d Emotional state<\/h5>\n<pee>Depression, grief, psychological suffering expressed through withdrawal from care.<\/pee><span class=\"cr-approche\">\u2192 Listening, addressing depression<\/span><\/div>\n<div class=\"cr\">\n<h5>\ud83c\udf00 Sensory hypersensitivity<\/h5>\n<pee>Some people (ASD, dementia) have sensory sensitivities that make certain care intolerable.<\/pee><span class=\"cr-approche\">\u2192 Adapt touch, environment<\/span><\/div>\n<\/p><\/div>\n<p>  <a href=\"https:\/\/www.dynseo.com\/en\/courses\/refusal-of-care-understanding-negotiating-and-respecting-a-gentle-and-ethical-approach-en\/\" style=\"display:block;text-decoration:none\"><\/p>\n<div class=\"formation-block\">\n      <img decoding=\"async\" src=\"https:\/\/www.dynseo.com\/wp-content\/uploads\/2026\/03\/autism-en-etablissement-Accompagnement-Global-31.jpg\" alt=\"Training refusal of care gentle ethical approach DYNSEO\" class=\"fb-img\"><\/p>\n<div class=\"fb-content\">\n        <span class=\"fb-tag\">\ud83c\udf93 QUALIOPI CERTIFIED TRAINING<\/span><\/p>\n<h3>Refusal of care: understanding, negotiating, and respecting \u2014 a gentle and ethical approach<\/h3>\n<pee>Online training at your own pace for healthcare professionals and family caregivers. Learn to identify the underlying causes of refusal of care, develop compassionate alternative approaches, and manage situations of ethical tension between autonomy and protection.<\/pee>\n<div class=\"fb-badges\">\n          <span class=\"fb-badge\">\u2705 Qualiopi Certified<\/span><br \/>\n          <span class=\"fb-badge\">\ud83d\udcbb 100% online<\/span><br \/>\n          <span class=\"fb-badge\">\u23f1\ufe0f At your own pace<\/span><br \/>\n          <span class=\"fb-badge\">\ud83c\udfe5 Professionals &amp; Families<\/span>\n        <\/div>\n<p>        <a href=\"https:\/\/www.dynseo.com\/en\/courses\/refusal-of-care-understanding-negotiating-and-respecting-a-gentle-and-ethical-approach-en\/\" class=\"fb-btn\">Access the training \u2192<\/a>\n      <\/div>\n<\/p><\/div>\n<p>  <\/a><\/p>\n<h2>2. Concrete approaches to support refusal of care<\/h2>\n<h3>2.1 The 3R rule: Recognize, Delay, Retry<\/h3>\n<div class=\"nc\">\n<div class=\"nb\">R1<\/div>\n<div>\n<h4>Recognize the refusal without fighting it<\/h4>\n<pee>&#8220;I understand that you don&#8217;t want to now&#8221; \u2014 validate the refusal without minimizing or forcing. This recognition immediately reduces tension. A resisted refusal intensifies; a recognized refusal sometimes opens up to negotiation.<\/pee><\/div>\n<\/div>\n<div class=\"nc\">\n<div class=\"nb\">R2<\/div>\n<div>\n<h4>Delay the care to another time<\/h4>\n<pee>Attempting care at the wrong time (fatigue, agitation, missed meal) is often counterproductive. Delaying by 30 minutes to an hour gives the person time to calm down and the caregiver the opportunity to return in a better relational context.<\/pee><\/div>\n<\/div>\n<div class=\"nc\">\n<div class=\"nb\">R3<\/div>\n<div>\n<h4>Retry with another approach or another person<\/h4>\n<pee>Some people systematically refuse care from certain caregivers and accept it from others. This relational preference is not arbitrary \u2014 it deserves to be respected and organized. Changing the order of care, the time, the setting, can transform a refusal into acceptance.<\/pee><\/div>\n<\/div>\n<h3>2.2 Adapt communication<\/h3>\n<div class=\"ub\">\n<h4>\ud83c\udfaf Approach from the front, introduce yourself each time<\/h4>\n<pee>Always introduce yourself before touching the person \u2014 even if they know you. &#8220;Hello Marie, it&#8217;s Sophie, I&#8217;m here to help you with your bath this morning.&#8221; For people with dementia, this systematic introduction reduces the element of surprise and associated anxiety.<\/pee><\/div>\n<div class=\"ub\">\n<h4>\ud83c\udfaf Offer choices rather than imposing<\/h4>\n<pee>&#8220;Would you prefer to start from the top or the bottom?&#8221; &#8220;Shall we take a shower now or in 10 minutes?&#8221; These micro-choices restore a sense of control that reduces resistance. The person no longer has a choice BETWEEN care and refusal \u2014 but a choice IN how to carry out the care.<\/pee><\/div>\n<div class=\"ub\">\n<h4>\ud83c\udfaf Use the person&#8217;s interests and habits<\/h4>\n<pee>Associating care with something pleasant for the person (favorite music during bathing, conversation on a loved topic during care) creates a positive association that gradually reduces refusal.<\/pee><\/div>\n<h3>2.3 When refusal persists \u2014 ethical framework and collegial decision<\/h3>\n<ul class=\"cl\">\n<li>Document refusals and alternative attempts made<\/li>\n<li>Gather the multidisciplinary team for a collegial ethical reflection<\/li>\n<li>Involve the family in finding solutions \u2014 while respecting the person&#8217;s wishes<\/li>\n<li>Consult the referring physician to assess real risks and therapeutic alternatives<\/li>\n<li>Never practice care by force \u2014 except in documented life-threatening emergencies<\/li>\n<\/ul>\n<div class=\"warn\"><pee>\u26a0\ufe0f <strong>Forced care is never a solution:<\/strong> Beyond the ethical and legal dimension, care imposed by force systematically worsens future refusal, traumatizes the person, and weakens the care relationship in the long term. It is always a loss \u2014 for the person AND for the team.<\/pee><\/div>\n<div class=\"tip\">\n<div class=\"ico\">\ud83d\udca1<\/div>\n<pee><strong>For caregiving teams:<\/strong> Refusal of care often generates guilt and exhaustion among caregivers. Regular speaking spaces (discussion groups, supervision) are essential for teams to navigate these difficult situations without burning out.<\/pee><\/div>\n<h2>3. DYNSEO resources and training<\/h2>\n<div class=\"oc\">\n<h4>\ud83d\udcda DYNSEO Resources \u2014 Refusal of care and support<\/h4>\n<ul>\n<li><a href=\"https:\/\/www.dynseo.com\/en\/courses\/refusal-of-care-understanding-negotiating-and-respecting-a-gentle-and-ethical-approach-en\/\">\ud83c\udf93 Refusal of care training (Qualiopi)<\/a><\/li>\n<li><a href=\"https:\/\/www.dynseo.com\/en\/our-tools\/warning-signs-card-dynseo-training\/\">\ud83d\udea6 Alert signal card<\/a><\/li>\n<li><a href=\"https:\/\/www.dynseo.com\/en\/our-tools\/asd-sensory-needs-map\/\">\ud83c\udf00 Sensory needs card<\/a><\/li>\n<li><a href=\"https:\/\/www.dynseo.com\/en\/our-tools\/tsa-crisis-management-plan\/\">\ud83d\udccb Crisis management plan<\/a><\/li>\n<li><a href=\"https:\/\/www.dynseo.com\/nos-outils\/boite-a-outils-regulation\/\">\ud83d\udc99 Emotional regulation toolbox<\/a><\/li>\n<li><a href=\"https:\/\/www.dynseo.com\/en\/our-training-courses\/\">\ud83c\udf93 All trainings<\/a><\/li>\n<\/ul><\/div>\n<div class=\"cards\">\n<div class=\"card\">\n<div class=\"ci ci-b\">\ud83d\udcf1<\/div>\n<h4>SCARLETT Application<\/h4>\n<pee><a href=\"https:\/\/www.dynseo.com\/en\/brain-games-apps\/scarlett-brain-games-for-seniors\/\" style=\"color:var(--blue)\">SCARLETT<\/a> can serve as a positive approach tool before care \u2014 creating a pleasant moment that facilitates acceptance.<\/pee><\/div>\n<div class=\"card\">\n<div class=\"ci ci-t\">\ud83d\udcf1<\/div>\n<h4>MY DICTIONARY Application<\/h4>\n<pee><a href=\"https:\/\/www.dynseo.com\/mon-dico-une-application-pour-favoriser-la-communication\/\" style=\"color:var(--blue)\">MY DICTIONARY<\/a> helps people express what they feel about care \u2014 and sometimes name what holds them back.<\/pee><\/div>\n<div class=\"card\">\n<div class=\"ci ci-y\">\ud83c\udf21\ufe0f<\/div>\n<h4>Emotion thermometer<\/h4>\n<pee>The <a href=\"https:\/\/www.dynseo.com\/en\/our-tools\/emotion-thermometer\/\" style=\"color:var(--blue)\">emotion thermometer<\/a> allows the person to indicate their state before care \u2014 a valuable signal for adapting the approach.<\/pee><\/div>\n<div class=\"card\">\n<div class=\"ci ci-p\">\ud83e\uddea<\/div>\n<h4>Cognitive tests<\/h4>\n<pee>The <a href=\"https:\/\/www.dynseo.com\/en\/our-tests\/\" style=\"color:var(--blue)\">DYNSEO cognitive tests<\/a> allow for assessing the level of understanding and adapting communication accordingly.<\/pee><\/div>\n<\/p><\/div>\n<div class=\"qte\"><pee>\u201cSince our team took the training on refusal of care, we have stopped seeing refusal as an obstacle to overcome. We see it as information about the person&#8217;s state. This way of seeing has changed our practices \u2014 and refusals have significantly decreased.\u201d<\/pee><cite>\u2014 Nursing assistant in a Nursing home, participant in DYNSEO training<\/cite><\/div>\n<div class=\"ccl\">\n<h2>Refusal of care is not a failure \u2014 it is an invitation to change approach<\/h2>\n<pee>Understanding refusal of care means understanding the person behind the refusal. DYNSEO training gives you the tools to shift from a confrontational stance to a collaborative stance \u2014 while respecting both care needs and the dignity of the person.<\/pee>\n    <a href=\"https:\/\/www.dynseo.com\/en\/courses\/refusal-of-care-understanding-negotiating-and-respecting-a-gentle-and-ethical-approach-en\/\" class=\"bcta\">Access the Qualiopi training \u2192<\/a>\n  <\/div>\n<p><\/main><\/p>\n<section class=\"faq-s\">\n<div class=\"container\">\n<h2>FAQ \u2014 Refusal of care<\/h2>\n<div class=\"fi\">\n<h4>Can a guardian accept care on behalf of a ward who refuses?<\/h4>\n<pee>No, not without conditions. French law protects the right to consent even for people under guardianship. For routine care, the consent of the person remains necessary despite the guardianship. For significant medical care, the guardianship judge can be involved. In case of vital emergency, the doctor can provide necessary care without consent. In all cases, the refusal of a person under guardianship must be documented and the situation discussed in a multidisciplinary team.<\/pee><\/div>\n<div class=\"fi\">\n<h4>How to distinguish between a refusal of care and an inability to consent (advanced dementia)?<\/h4>\n<pee>This is a central ethical and clinical question. In practice: a refusal expressed through clear behavior (pushing away a hand, turning the head, shouting) must be respected even in the absence of verbal capacity. Attempt to assess whether the behavior is consistent over time (systematic refusal of certain care) or situational (refusal related to a temporary state of agitation). Consulting a referring physician and an ethics committee is recommended for complex situations.<\/pee><\/div>\n<div class=\"fi\">\n<h4>How to manage the refusal of care in the face of a family that demands &#8220;to do something&#8221;?<\/h4>\n<pee>The tension between respecting the person&#8217;s refusal and the family&#8217;s demands is common. Clearly explain to the family the legal framework (the right to refuse care is fundamental) and ethical (forcing worsens the situation). Propose a family meeting with the referring physician to align understandings. Document all alternative attempts made and their results. If the tension persists, a health mediator or an ethics committee may be sought.<\/pee><\/div>\n<div class=\"fi\">\n<h4>Is the refusal to eat treated as a refusal of care?<\/h4>\n<pee>Yes \u2014 the refusal to eat is a particularly delicate refusal of care as it directly impacts vital prognosis. The approach is the same: first understand (oral pain? disgust for textures? depression? simple lack of appetite?) before considering any alternatives (modified texture, enriched diet, supplements, enteral feeding). Placing a nasogastric tube against the will of a conscious person is legally and ethically problematic and is only accepted under very strict conditions.<\/pee><\/div>\n<div class=\"fi\">\n<h4>Does the DYNSEO training on refusal of care also cover refusal of care in disabled individuals (ASD, intellectual disability)?<\/h4>\n<pee>Yes \u2014 the DYNSEO training &#8220;Refusal of care: understanding, negotiating, and respecting&#8221; covers refusal of care in several contexts, including intellectual disability and ASD. For autistic individuals, the specific mechanisms of refusal (sensory hypersensitivities, anxiety related to changes in routine, communication difficulties) are covered with adapted approaches. DYNSEO tools like the sensory needs map and the alert signals map are directly integrated into the practical recommendations of the training.<\/pee><\/div>\n<\/p><\/div>\n<\/section>\n<footer>\n  <pee>DYNSEO \u2014 Certified training and applications for professionals and families<\/pee>\n<div class=\"fl\">\n    <a href=\"https:\/\/www.dynseo.com\/en\/courses\/refusal-of-care-understanding-negotiating-and-respecting-a-gentle-and-ethical-approach-en\/\">Refusal of care training<\/a><br \/>\n    <a href=\"https:\/\/www.dynseo.com\/en\/our-training-courses\/\">All trainings<\/a><br \/>\n    <a href=\"https:\/\/www.dynseo.com\/en\/our-tools\/\">Free tools<\/a><br \/>\n    <a href=\"https:\/\/www.dynseo.com\/en\/brain-games-apps\/scarlett-brain-games-for-seniors\/\">SCARLETT application<\/a>\n  <\/div>\n<\/footer>\n<\/div>\n<p>[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":4,"featured_media":412655,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"[et_pb_section fb_built=\"1\" admin_label=\"Article HTML\" _builder_version=\"4.16\" custom_padding=\"0px||0px||false|false\" global_colors_info=\"{}\"][et_pb_row admin_label=\"Contenu\" _builder_version=\"4.16\" width=\"100%\" max_width=\"100%\" custom_padding=\"0px||0px||false|false\" global_colors_info=\"{}\"][et_pb_column type=\"4_4\" _builder_version=\"4.16\" global_colors_info=\"{}\"][et_pb_code admin_label=\"HTML import\u00e9\" _builder_version=\"4.16\" global_colors_info=\"{}\"]<style 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{color:rgba(255,255,255,.8);font-size:13px;margin-bottom:12px}\n.dbi-art-61bc1a .fl {display:flex;justify-content:center;gap:10px;flex-wrap:wrap}\n.dbi-art-61bc1a .fl a {color:#fff;text-decoration:none;font-size:12px;font-weight:600;padding:6px 14px;border:1px solid rgba(255,255,255,.3);border-radius:50px}\n@media(max-width:560px) {\n.dbi-art-61bc1a .cards {grid-template-columns:1fr}\n}\n.dbi-art-61bc1a .banner {background:linear-gradient(135deg,var(--pink),#c0204e);padding:22px 20px;text-align:center}\n.dbi-art-61bc1a .banner p {color:#fff;font-size:14px;margin:0 0 12px}\n.dbi-art-61bc1a .bws {display:inline-block;background:#fff;color:var(--pink);font-family:'Montserrat',sans-serif;font-weight:700;font-size:13px;padding:9px 22px;border-radius:50px;text-decoration:none}\n\n<\/style>\n<div class=\"dbi-art-61bc1a\">\n<header class=\"hero\">\n  <div class=\"hero-tag\">\ud83e\udd1d Refusal of care \u00b7 Ethics \u00b7 Behavioral disorders \u00b7 Caregivers<\/div>\n  <h1>Refusal of care: understanding and acting \u2014<br>guide for families and caregivers<\/h1>\n  <p class=\"hero-sub\">Understand the mechanisms of refusal of care in elderly or vulnerable people, adopt a gentle and ethical approach, and find solutions that respect both the dignity of the person and safety requirements<\/p>\n<\/header>\n<div class=\"banner\">\n  <p>\ud83c\udf93 Qualiopi certified training \u00b7 Online \u00b7 At your own pace<\/p>\n  <a href=\"https:\/\/www.dynseo.com\/courses\/refus-de-soins-comprendre-negocier-et-respecter-une-approche-douce-et-ethique\/\" class=\"bws\">Access the training: Refusal of care \u2014 gentle and ethical approach \u2192<\/a>\n<\/div>\n<main class=\"container\">\n  <div class=\"intro\"><p>Your loved one refuses to take their medication. Your resident pushes back against any attempt at bathing. The person you are accompanying says \"no\" to every proposed care. Refusal of care is one of the most frequent and destabilizing challenges in geriatrics, palliative care, and disability support. It puts two fundamental values in tension: respect for the person's autonomy and the duty of protective care. This guide gives you the keys to navigate this tension with humanity and effectiveness.<\/p><\/div>\n\n  <h2>1. Refusal of care: understand before acting<\/h2>\n\n  <div class=\"hl\">\n    <h4>\u2696\ufe0f The ethical and legal framework<\/h4>\n    <p>In France, the right to refuse care is fundamental: any adult and capable person has the right to refuse any medical or care act, even if this refusal endangers their life (law of March 4, 2002). This right also applies to people under guardianship or curatorship \u2014 the guardian cannot accept care on behalf of the person without their consent, except in urgent medical exceptions. The caregiver is not exempt from their obligation to inform and propose care \u2014 but they cannot impose it.<\/p>\n  <\/div>\n\n  <h3>1.1 The causes of refusal of care: behavior that always has meaning<\/h3>\n\n  <div class=\"causes-refus\">\n    <div class=\"cr\"><h5>\ud83d\ude23 Pain or discomfort<\/h5><p>The care is associated with past or anticipated physical pain. Often underestimated.<\/p><span class=\"cr-approche\">\u2192 Systematic pain assessment<\/span><\/div>\n    <div class=\"cr\"><h5>\ud83d\ude28 Anxiety and fear<\/h5><p>Fear of what will happen, of losing control, of the unknown. Common in dementia.<\/p><span class=\"cr-approche\">\u2192 Preparation, explanation, reassurance<\/span><\/div>\n    <div class=\"cr\"><h5>\ud83d\udd12 Cognitive disorder<\/h5><p>The person does not understand what is being proposed. Disorientation, distrust, confusion.<\/p><span class=\"cr-approche\">\u2192 Adapted communication, routine<\/span><\/div>\n    <div class=\"cr\"><h5>\ud83d\udeab Expression of autonomy<\/h5><p>The refusal is a way of saying \"I still exist, I have the right to decide.\" Especially in institutions.<\/p><span class=\"cr-approche\">\u2192 Offer choices, respect agency<\/span><\/div>\n    <div class=\"cr\"><h5>\ud83d\ude2d Emotional state<\/h5><p>Depression, grief, psychological suffering expressed through withdrawal from care.<\/p><span class=\"cr-approche\">\u2192 Listening, addressing depression<\/span><\/div>\n    <div class=\"cr\"><h5>\ud83c\udf00 Sensory hypersensitivity<\/h5><p>Some people (ASD, dementia) have sensory sensitivities that make certain care intolerable.<\/p><span class=\"cr-approche\">\u2192 Adapt touch, environment<\/span><\/div>\n  <\/div>\n\n  <a href=\"https:\/\/www.dynseo.com\/courses\/refus-de-soins-comprendre-negocier-et-respecter-une-approche-douce-et-ethique\/\" style=\"display:block;text-decoration:none\">\n    <div class=\"formation-block\">\n      <img src=\"https:\/\/www.dynseo.com\/wp-content\/uploads\/2026\/03\/autism-en-etablissement-Accompagnement-Global-31.jpg\" alt=\"Training refusal of care gentle ethical approach DYNSEO\" class=\"fb-img\">\n      <div class=\"fb-content\">\n        <span class=\"fb-tag\">\ud83c\udf93 QUALIOPI CERTIFIED TRAINING<\/span>\n        <h3>Refusal of care: understanding, negotiating, and respecting \u2014 a gentle and ethical approach<\/h3>\n        <p>Online training at your own pace for healthcare professionals and family caregivers. Learn to identify the underlying causes of refusal of care, develop compassionate alternative approaches, and manage situations of ethical tension between autonomy and protection.<\/p>\n        <div class=\"fb-badges\">\n          <span class=\"fb-badge\">\u2705 Qualiopi Certified<\/span>\n          <span class=\"fb-badge\">\ud83d\udcbb 100% online<\/span>\n          <span class=\"fb-badge\">\u23f1\ufe0f At your own pace<\/span>\n          <span class=\"fb-badge\">\ud83c\udfe5 Professionals &amp; Families<\/span>\n        <\/div>\n        <a href=\"https:\/\/www.dynseo.com\/courses\/refus-de-soins-comprendre-negocier-et-respecter-une-approche-douce-et-ethique\/\" class=\"fb-btn\">Access the training \u2192<\/a>\n      <\/div>\n    <\/div>\n  <\/a>\n\n  <h2>2. Concrete approaches to support refusal of care<\/h2>\n\n  <h3>2.1 The 3R rule: Recognize, Delay, Retry<\/h3>\n  <div class=\"nc\"><div class=\"nb\">R1<\/div><div><h4>Recognize the refusal without fighting it<\/h4><p>\"I understand that you don't want to now\" \u2014 validate the refusal without minimizing or forcing. This recognition immediately reduces tension. A resisted refusal intensifies; a recognized refusal sometimes opens up to negotiation.<\/p><\/div><\/div>\n  <div class=\"nc\"><div class=\"nb\">R2<\/div><div><h4>Delay the care to another time<\/h4><p>Attempting care at the wrong time (fatigue, agitation, missed meal) is often counterproductive. Delaying by 30 minutes to an hour gives the person time to calm down and the caregiver the opportunity to return in a better relational context.<\/p><\/div><\/div>\n  <div class=\"nc\"><div class=\"nb\">R3<\/div><div><h4>Retry with another approach or another person<\/h4><p>Some people systematically refuse care from certain caregivers and accept it from others. This relational preference is not arbitrary \u2014 it deserves to be respected and organized. Changing the order of care, the time, the setting, can transform a refusal into acceptance.<\/p><\/div><\/div>\n\n  <h3>2.2 Adapt communication<\/h3>\n  <div class=\"ub\"><h4>\ud83c\udfaf Approach from the front, introduce yourself each time<\/h4><p>Always introduce yourself before touching the person \u2014 even if they know you. \"Hello Marie, it's Sophie, I'm here to help you with your bath this morning.\" For people with dementia, this systematic introduction reduces the element of surprise and associated anxiety.<\/p><\/div>\n  <div class=\"ub\"><h4>\ud83c\udfaf Offer choices rather than imposing<\/h4><p>\"Would you prefer to start from the top or the bottom?\" \"Shall we take a shower now or in 10 minutes?\" These micro-choices restore a sense of control that reduces resistance. The person no longer has a choice BETWEEN care and refusal \u2014 but a choice IN how to carry out the care.<\/p><\/div>\n  <div class=\"ub\"><h4>\ud83c\udfaf Use the person's interests and habits<\/h4><p>Associating care with something pleasant for the person (favorite music during bathing, conversation on a loved topic during care) creates a positive association that gradually reduces refusal.<\/p><\/div>\n\n  <h3>2.3 When refusal persists \u2014 ethical framework and collegial decision<\/h3>\n  <ul class=\"cl\">\n    <li>Document refusals and alternative attempts made<\/li>\n    <li>Gather the multidisciplinary team for a collegial ethical reflection<\/li>\n    <li>Involve the family in finding solutions \u2014 while respecting the person's wishes<\/li>\n    <li>Consult the referring physician to assess real risks and therapeutic alternatives<\/li>\n    <li>Never practice care by force \u2014 except in documented life-threatening emergencies<\/li>\n  <\/ul>\n\n  <div class=\"warn\"><p>\u26a0\ufe0f <strong>Forced care is never a solution:<\/strong> Beyond the ethical and legal dimension, care imposed by force systematically worsens future refusal, traumatizes the person, and weakens the care relationship in the long term. It is always a loss \u2014 for the person AND for the team.<\/p><\/div>\n\n  <div class=\"tip\"><div class=\"ico\">\ud83d\udca1<\/div><p><strong>For caregiving teams:<\/strong> Refusal of care often generates guilt and exhaustion among caregivers. Regular speaking spaces (discussion groups, supervision) are essential for teams to navigate these difficult situations without burning out.<\/p><\/div>\n\n  <h2>3. DYNSEO resources and training<\/h2>\n  <div class=\"oc\">\n    <h4>\ud83d\udcda DYNSEO Resources \u2014 Refusal of care and support<\/h4>\n    <ul>\n      <li><a href=\"https:\/\/www.dynseo.com\/courses\/refus-de-soins-comprendre-negocier-et-respecter-une-approche-douce-et-ethique\/\">\ud83c\udf93 Refusal of care training (Qualiopi)<\/a><\/li>\n      <li><a href=\"https:\/\/www.dynseo.com\/nos-outils\/carte-signaux-alerte\/\">\ud83d\udea6 Alert signal card<\/a><\/li>\n      <li><a href=\"https:\/\/www.dynseo.com\/nos-outils\/carte-des-besoins-sensoriels-tsa\/\">\ud83c\udf00 Sensory needs card<\/a><\/li>\n      <li><a href=\"https:\/\/www.dynseo.com\/nos-outils\/plan-de-gestion-des-crises-tsa\/\">\ud83d\udccb Crisis management plan<\/a><\/li>\n      <li><a href=\"https:\/\/www.dynseo.com\/nos-outils\/boite-a-outils-regulation\/\">\ud83d\udc99 Emotional regulation toolbox<\/a><\/li>\n      <li><a href=\"https:\/\/www.dynseo.com\/nos-formations\/\">\ud83c\udf93 All trainings<\/a><\/li>\n    <\/ul>\n  <\/div>\n  <div class=\"cards\">\n    <div class=\"card\"><div class=\"ci ci-b\">\ud83d\udcf1<\/div><h4>SCARLETT Application<\/h4><p><a href=\"https:\/\/www.dynseo.com\/en\/brain-games-apps\/scarlett-brain-games-for-seniors\/\" style=\"color:var(--blue)\">SCARLETT<\/a> can serve as a positive approach tool before care \u2014 creating a pleasant moment that facilitates acceptance.<\/p><\/div>\n    <div class=\"card\"><div class=\"ci ci-t\">\ud83d\udcf1<\/div><h4>MY DICTIONARY Application<\/h4><p><a href=\"https:\/\/www.dynseo.com\/mon-dico-une-application-pour-favoriser-la-communication\/\" style=\"color:var(--blue)\">MY DICTIONARY<\/a> helps people express what they feel about care \u2014 and sometimes name what holds them back.<\/p><\/div>\n    <div class=\"card\"><div class=\"ci ci-y\">\ud83c\udf21\ufe0f<\/div><h4>Emotion thermometer<\/h4><p>The <a href=\"https:\/\/www.dynseo.com\/nos-outils\/thermometre-des-emotions\/\" style=\"color:var(--blue)\">emotion thermometer<\/a> allows the person to indicate their state before care \u2014 a valuable signal for adapting the approach.<\/p><\/div>\n    <div class=\"card\"><div class=\"ci ci-p\">\ud83e\uddea<\/div><h4>Cognitive tests<\/h4><p>The <a href=\"https:\/\/www.dynseo.com\/nos-tests\/\" style=\"color:var(--blue)\">DYNSEO cognitive tests<\/a> allow for assessing the level of understanding and adapting communication accordingly.<\/p><\/div>\n  <\/div>\n\n  <div class=\"qte\"><p>\u201cSince our team took the training on refusal of care, we have stopped seeing refusal as an obstacle to overcome. We see it as information about the person's state. This way of seeing has changed our practices \u2014 and refusals have significantly decreased.\u201d<\/p><cite>\u2014 Nursing assistant in a Nursing home, participant in DYNSEO training<\/cite><\/div>\n\n  <div class=\"ccl\">\n    <h2>Refusal of care is not a failure \u2014 it is an invitation to change approach<\/h2>\n    <p>Understanding refusal of care means understanding the person behind the refusal. DYNSEO training gives you the tools to shift from a confrontational stance to a collaborative stance \u2014 while respecting both care needs and the dignity of the person.<\/p>\n    <a href=\"https:\/\/www.dynseo.com\/courses\/refus-de-soins-comprendre-negocier-et-respecter-une-approche-douce-et-ethique\/\" class=\"bcta\">Access the Qualiopi training \u2192<\/a>\n  <\/div>\n<\/main>\n<section class=\"faq-s\">\n<div class=\"container\">\n    <h2>FAQ \u2014 Refusal of care<\/h2>\n    <div class=\"fi\"><h4>Can a guardian accept care on behalf of a ward who refuses?<\/h4><p>No, not without conditions. French law protects the right to consent even for people under guardianship. For routine care, the consent of the person remains necessary despite the guardianship. For significant medical care, the guardianship judge can be involved. In case of vital emergency, the doctor can provide necessary care without consent. In all cases, the refusal of a person under guardianship must be documented and the situation discussed in a multidisciplinary team.<\/p><\/div>\n    <div class=\"fi\"><h4>How to distinguish between a refusal of care and an inability to consent (advanced dementia)?<\/h4><p>This is a central ethical and clinical question. In practice: a refusal expressed through clear behavior (pushing away a hand, turning the head, shouting) must be respected even in the absence of verbal capacity. Attempt to assess whether the behavior is consistent over time (systematic refusal of certain care) or situational (refusal related to a temporary state of agitation). Consulting a referring physician and an ethics committee is recommended for complex situations.<\/p><\/div>\n    <div class=\"fi\"><h4>How to manage the refusal of care in the face of a family that demands \"to do something\"?<\/h4><p>The tension between respecting the person's refusal and the family's demands is common. Clearly explain to the family the legal framework (the right to refuse care is fundamental) and ethical (forcing worsens the situation). Propose a family meeting with the referring physician to align understandings. Document all alternative attempts made and their results. If the tension persists, a health mediator or an ethics committee may be sought.<\/p><\/div>\n    <div class=\"fi\"><h4>Is the refusal to eat treated as a refusal of care?<\/h4><p>Yes \u2014 the refusal to eat is a particularly delicate refusal of care as it directly impacts vital prognosis. The approach is the same: first understand (oral pain? disgust for textures? depression? simple lack of appetite?) before considering any alternatives (modified texture, enriched diet, supplements, enteral feeding). Placing a nasogastric tube against the will of a conscious person is legally and ethically problematic and is only accepted under very strict conditions.<\/p><\/div>\n    <div class=\"fi\"><h4>Does the DYNSEO training on refusal of care also cover refusal of care in disabled individuals (ASD, intellectual disability)?<\/h4><p>Yes \u2014 the DYNSEO training \"Refusal of care: understanding, negotiating, and respecting\" covers refusal of care in several contexts, including intellectual disability and ASD. For autistic individuals, the specific mechanisms of refusal (sensory hypersensitivities, anxiety related to changes in routine, communication difficulties) are covered with adapted approaches. DYNSEO tools like the sensory needs map and the alert signals map are directly integrated into the practical recommendations of the training.<\/p><\/div>\n  <\/div>\n<\/section>\n<footer>\n  <p>DYNSEO \u2014 Certified training and applications for professionals and families<\/p>\n  <div class=\"fl\">\n    <a href=\"https:\/\/www.dynseo.com\/courses\/refus-de-soins-comprendre-negocier-et-respecter-une-approche-douce-et-ethique\/\">Refusal of care training<\/a>\n    <a href=\"https:\/\/www.dynseo.com\/nos-formations\/\">All trainings<\/a>\n    <a href=\"https:\/\/www.dynseo.com\/nos-outils\/\">Free tools<\/a>\n    <a href=\"https:\/\/www.dynseo.com\/en\/brain-games-apps\/scarlett-brain-games-for-seniors\/\">SCARLETT application<\/a>\n  <\/div>\n<\/footer>\n<\/div>[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section]","_et_gb_content_width":"","footnotes":""},"categories":[2915],"tags":[],"class_list":["post-722093","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-les-conseils-des-coachs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Refusal of Care: Understanding and Acting - Guide for Families and Caregivers - DYNSEO - DYNSEO - Educational apps &amp; 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