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En France, le consentement libre et \u00e9clair\u00e9 est un principe inscrit dans le Code de la sant\u00e9 publique : une personne inform\u00e9e peut refuser un soin, m\u00eame quand ce refus para\u00eet d\u00e9raisonnable au professionnel. Le r\u00f4le de l'\u00e9quipe est alors d'informer clairement, de rechercher la cause du refus, de proposer autrement et de tracer la d\u00e9cision. Chez une personne dont le discernement est alt\u00e9r\u00e9, la personne de confiance, les directives anticip\u00e9es et l'avis m\u00e9dical entrent en jeu. Forcer un soin en dehors de tout cadre expose la personne et engage la responsabilit\u00e9 du professionnel : le refus se respecte, il ne se contourne pas.\"\n          }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Refus de soins, que faire quand il y a urgence vitale ?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"La situation change de nature. Devant une d\u00e9tresse vitale \u2014 perte de connaissance, difficult\u00e9 respiratoire majeure, h\u00e9morragie, signes \u00e9voquant un AVC \u2014, on met la personne en s\u00e9curit\u00e9, on applique la proc\u00e9dure d'urgence de l'\u00e9tablissement et on contacte les services d'urgence de votre pays. L'urgence prime sur l'analyse du refus. En dehors de l'urgence vitale, en revanche, un refus se travaille : on ne transforme pas chaque opposition en situation d'urgence pour justifier de passer outre. En cas de doute sur le caract\u00e8re urgent, on sollicite sans attendre l'infirmi\u00e8re, le cadre ou le m\u00e9decin.\"\n          }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Comment ne pas forcer sans pour autant \u00ab laisser tomber \u00bb le soin ?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"Ne pas forcer n'est pas renoncer. C'est d\u00e9placer l'effort du \u00ab si \u00bb vers le \u00ab comment \u00bb : reporter \u00e0 un meilleur moment, d\u00e9couper le soin en petites \u00e9tapes, proposer un choix, changer d'intervenant, adapter l'environnement. Un soin report\u00e9 et accept\u00e9 vaut mieux qu'un soin arrach\u00e9 qui fera refuser le lendemain. Quand le refus persiste malgr\u00e9 ces ajustements, on ne s'obstine pas seul : on transmet pr\u00e9cis\u00e9ment ce qui a \u00e9t\u00e9 tent\u00e9 et on porte la question en \u00e9quipe. C'est cette combinaison \u2014 souplesse sur la forme, exigence sur l'objectif, d\u00e9cision collective \u2014 qui prot\u00e8ge \u00e0 la fois la personne et la qualit\u00e9 du soin.\"\n          }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Que noter dans les transmissions apr\u00e8s un refus ?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"Un fait dat\u00e9, situ\u00e9 et reproductible, pas une interpr\u00e9tation. \u00ab Refus de la toilette \u00e0 7 h 40, accept\u00e9e \u00e0 9 h apr\u00e8s le caf\u00e9 \u00bb est exploitable : cela oriente et permet de d\u00e9cider en \u00e9quipe. \u00ab Opposant \u00bb ou \u00ab capricieuse \u00bb n'apporte rien et suit la personne pendant des mois en orientant \u00e0 tort les coll\u00e8gues suivants. Notez aussi ce qui a fonctionn\u00e9 : l'heure, la formulation, l'intervenant, l'am\u00e9nagement. Ces informations positives valent autant que le refus lui-m\u00eame, car elles rendent le prochain soin possible. Une transmission utile d\u00e9crit un comportement observable, jamais une \u00e9tiquette de personnalit\u00e9.\"\n          }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Comment prot\u00e9ger l'\u00e9quipe face aux refus r\u00e9p\u00e9t\u00e9s ?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"Un refus qui revient use : sentiment d'\u00e9chec, tension, parfois culpabilit\u00e9. Le premier levier est de sortir de l'isolement : en parler en r\u00e9union, d\u00e9cider collectivement du niveau d'aide et des consignes, \u00e9crire ce qui marche pour que chacun applique la m\u00eame chose, y compris les rempla\u00e7ants. Le deuxi\u00e8me est de se rappeler qu'un refus respect\u00e9 n'est pas une faute professionnelle : c'est souvent le signe d'un accompagnement de qualit\u00e9. Se former donne enfin un vocabulaire commun et des rep\u00e8res partag\u00e9s, ce qui apaise l'\u00e9quipe autant que la relation avec la personne accompagn\u00e9e.\"\n          }\n        }\n      ]\n    }\n  ]\n}\n<\/script><\/p>\n<div class=\"dbi-art-5e4859\">\n<!--\n\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\nDYNSEO \u2014 SEO\/GEO ARTICLE TEMPLATE \u00b7 v1.0\nDo not modify class names: the script generer-articles.py\nand all previously published articles depend on it.\n\nThe script generer-articles.py injects, in order: the colored header,\nthe training or tool box, the written body, then the structured data.\n\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n--><\/p>\n<div class=\"dyn-article\">\n<header class=\"dyn-pagehead dyn-pagehead--eau\">\n  <span class=\"dyn-pagehead__cat\">Professionals \u00b7 Behavioral disorders<\/span><\/p>\n<h1>Refusal of care: 10 difficult everyday situations and how to respond<\/h1>\n<pee class=\"dyn-pagehead__lead\">Refusal of care almost never occurs in major decisions. It happens in ordinary moments: a glove offered at the edge of the bed, a pill placed in the palm of the hand, a protection to change on a tired evening, a child curling up when approached. The recurring question, the same for the caregiver in a Nursing home, the educator in a specialized institution, or the nurse at home, can be summed up in three words: <strong>refusal of care, what to do<\/strong>? Not in theory, but in the moment, with the person in front of you and the schedule pressing.<\/pee>\n<ul class=\"dyn-pagehead__meta\">\n<li>\u23f1\ufe0f 18 min read<\/li>\n<li>\ud83d\udc65 For professionals<\/li>\n<li>\ud83d\udd04 Updated in August 2026<\/li>\n<\/ul>\n<\/header>\n<aside class=\"dyn-hero\" aria-label=\"Training presented in this article\">\n<div class=\"dyn-hero__grid\">\n<div class=\"dyn-hero__media\"><a href=\"https:\/\/www.dynseo.com\/en\/courses\/refusal-of-care-understanding-negotiating-and-respecting-a-gentle-and-ethical-approach-en\/\"><img decoding=\"async\" src=\"https:\/\/www.dynseo.com\/wp-content\/uploads\/2026\/04\/autism-en-etablissement-Accompagnement-Global-161-pdf.jpg\" alt=\"DYNSEO Training 'Refusal of care: understanding, negotiating, and respecting \u2014 a gentle and ethical approach'\" width=\"1920\" height=\"1080\" loading=\"lazy\"><\/a><\/div>\n<div class=\"dyn-hero__body\">\n      <span class=\"dyn-hero__eyebrow\">The training related to this article<\/span>\n      <pee class=\"dyn-hero__title\"><a href=\"https:\/\/www.dynseo.com\/en\/courses\/refusal-of-care-understanding-negotiating-and-respecting-a-gentle-and-ethical-approach-en\/\">Refusal of care: understanding, negotiating, and respecting \u2014 a gentle and ethical approach<\/a><\/pee>\n      <pee class=\"dyn-hero__pitch\">Everything this article explains, put into practice.<\/pee>\n<ul class=\"dyn-badges\">\n<li>\ud83c\udfa5 5 modules \u00b7 16 lessons<\/li>\n<li>\ud83d\udcbb 100% online<\/li>\n<li>\u23f1\ufe0f At your own pace<\/li>\n<li>\ud83c\udfc5 Qualiopi organization<\/li>\n<li>\ud83c\udf0d 9 languages<\/li>\n<\/ul>\n<div class=\"dyn-hero__actions\">\n        <a class=\"dyn-btn\" href=\"https:\/\/www.dynseo.com\/en\/courses\/refusal-of-care-understanding-negotiating-and-respecting-a-gentle-and-ethical-approach-en\/\">See the training<\/a><br \/>\n        <span class=\"dyn-hero__price\">90.0 \u20ac<\/span>\n      <\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/aside>\n<pee>Here are ten of these situations, described as they actually occur. For each one: the scene, what is happening behind the &#8220;no&#8221;, the spontaneous reaction that makes everything worse, and then the step-by-step response \u2014 with the exact words to say and the gestures that work. No medical protocol here: just a way to observe, to defuse, to respect, and to communicate. The rest always falls to the team and the healthcare professional.<\/pee>\n<p><!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 SHORT RESPONSE (GEO) \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 --><\/p>\n<section class=\"dyn-tldr\">\n<h2>The essentials in 30 seconds<\/h2>\n<pee>A refusal is almost never a whim. It&#8217;s a message: fear, pain, fatigue, misunderstanding, or simply a need to maintain control over one&#8217;s life. Responding means first seeking that message before trying to convince.<\/pee>\n<ul>\n<li><strong>Refusal is a right<\/strong> before being a problem: consent, and thus refusal, are enshrined in law.<\/li>\n<li><strong>Look for the cause before the solution.<\/strong> A new refusal from someone usually cooperative first suggests pain or discomfort.<\/li>\n<li><strong>Negotiate the &#8220;how&#8221;, not the &#8220;if&#8221;.<\/strong> Keep the goal, let go of the rest: the time, the order, the portion, the person providing care.<\/li>\n<li><strong>Forcing resolves the minute and damages the relationship<\/strong> \u2014 and thus all subsequent care.<\/li>\n<li><strong>A useful transmission<\/strong> describes a dated and situated fact, never a label like &#8220;opponent&#8221;.<\/li>\n<\/ul>\n<\/section>\n<nav class=\"dyn-toc\" aria-label=\"Table of contents\">\n  <pee>The 10 situations<\/pee>\n<ol>\n<li><a href=\"#dyn-s1\">The morning wash refused<\/a><\/li>\n<li><a href=\"#dyn-s2\">The pill spat out or pushed away<\/a><\/li>\n<li><a href=\"#dyn-s3\">The meal left aside<\/a><\/li>\n<li><a href=\"#dyn-s4\">\u201cI&#8217;m not getting up today\u201d<\/a><\/li>\n<li><a href=\"#dyn-s5\">The change refused, the intimate care blocked<\/a><\/li>\n<li><a href=\"#dyn-s6\">The refusal that escalates into screams<\/a><\/li>\n<li><a href=\"#dyn-s7\">\u201cNot you\u201d \u2014 the refusal directed at a caregiver<\/a><\/li>\n<li><a href=\"#dyn-s8\">The refusal without words<\/a><\/li>\n<li><a href=\"#dyn-s9\">The young person refusing in an institution<\/a><\/li>\n<li><a href=\"#dyn-s10\">\u201cDon&#8217;t force her\u201d \u2014 the family opposes<\/a><\/li>\n<li><a href=\"#dyn-recap\">Refusal of care, what to do: the summary table<\/a><\/li>\n<li><a href=\"#dyn-faq\">Frequently asked questions<\/a><\/li>\n<\/ol>\n<\/nav>\n<p><!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 1 \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 --><\/p>\n<h2 id=\"dyn-s1\">1. The morning wash refused<\/h2>\n<pee><em>7:40 AM. You enter with the washcloth and towel, the light turned on suddenly. \u201cIt&#8217;s time for the wash!\u201d She pulls the sheet up to her chin, turns her head, says no, then nothing. You have five more people before breakfast.<\/em><\/pee>\n<pee>What is happening: the wash is the most intimate care there is, and it comes at the worst cognitive moment for many people \u2014 waking up, disorientation, sometimes the pain of the first movements. The \u201cno\u201d rarely says \u201cnever\u201d: it says \u201cnot like this, not now, not surprised in my sleep\u201d. The spontaneous reaction that makes everything worse is to insist, to pull back the sheet, or to return with two people: the person feels forced and the refusal solidifies for the week.<\/pee>\n<ol class=\"dyn-steps\">\n<li><strong>Knock, announce, leave some time.<\/strong> \u201cHello Madam, it&#8217;s Julie. I&#8217;m going to open the curtain a little, let&#8217;s take our time.\u201d We enter into a relationship, not into a room.<\/li>\n<li><strong>Offer a choice, not an order.<\/strong> \u201cShall we start with the face or the hands?\u201d The choice gives control back to the person without taking away from the goal.<\/li>\n<li><strong>Negotiate the portion.<\/strong> An upper body wash accepted today is better than a full wash imposed that will lead to refusal tomorrow.<\/li>\n<li><strong>Explicitly postpone<\/strong> if the refusal holds: \u201cOkay, I&#8217;ll come back in twenty minutes, after your coffee.\u201d An announced postponement is not a failure, it&#8217;s an agreement.<\/li>\n<\/ol>\n<pee><strong>\u274c To avoid:<\/strong> \u201cYou have to wash well, come on, let&#8217;s go\u201d while uncovering the person. You don&#8217;t win a wash by force without losing the trust that made it possible.<\/pee>\n<pee>To prevent this from happening again, note the time and conditions that work: if the wash consistently happens after coffee, that&#8217;s an organizational fact to bring up in meetings, not a preference to reinvent every morning.<\/pee>\n<p><!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 2 \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 --><\/p>\n<h2 id=\"dyn-s2\">2. The pill spat out or pushed away<\/h2>\n<pee><em>You extend the evening pillbox. She looks at the pills, presses her lips together, pushes your hand away. Everything went down without a word yesterday. A colleague whispers to you: \u201cCrush them in the applesauce, it&#8217;ll go down.\u201d<\/em><\/pee>\n<pee>What is happening: a new medication refusal, from someone who took everything the day before, must first seek a cause. The High Authority of Health reminds us that in the face of any change in behavior, we first look for a somatic cause: pain, sores, bad taste, difficulty swallowing, a pill too big, distrust related to a confused state. The refusal can also be a lucid decision that must be heard. Crushing a treatment in secret can be dangerous (some forms cannot be crushed) and deprives the person of their consent.<\/pee>\n<ol class=\"dyn-steps\">\n<li><strong>Look for the concrete obstacle.<\/strong> \u201cDoes it bother you to swallow? Is it the taste? Do you have pain somewhere?\u201d Often the answer is there.<\/li>\n<li><strong>Don&#8217;t crush anything on your own initiative.<\/strong> Modifying a galenic form falls under a prescription and pharmaceutical advice, never a hallway arrangement.<\/li>\n<li><strong>Offer a simple alternative<\/strong> already planned: a little water, another nearby moment, without concealment.<\/li>\n<li><strong>Report and document.<\/strong> \u201cRefusal of the evening treatment, pills pushed away, complains of throat pain.\u201d The nurse and doctor decide on the next steps.<\/li>\n<\/ol>\n<pee><strong>\u274c To avoid:<\/strong> hiding the medication in food without explicit prescription. It&#8217;s a violation of consent, sometimes a risk, and it destroys trust the day the person realizes it.<\/pee>\n<p><!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 3 \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 --><\/p>\n<h2 id=\"dyn-s3\">3. The meal left aside<\/h2>\n<pee><em>Noon. The tray is untouched, the fork hasn&#8217;t moved. \u201cI&#8217;m not hungry, take it away.\u201d You know she hardly ate anything at breakfast either. Service time is running out, it needs to be cleared.<\/em><\/pee>\n<pee>What is happening: a food refusal covers very different realities that cannot be sliced alone. Dental pain, swallowing disorder, nausea related to treatment, depression, grief, a dish that does not match cultural or religious habits, or simply a real absence of hunger that day. Repeated refusals and weight loss are signals for vigilance. Insisting, scolding, or forcing someone to eat only tightens and increases refusal at the next meal.<\/pee>\n<ol class=\"dyn-steps\">\n<li><strong>Stay, sit for a minute.<\/strong> A tray accompanied goes down better than a tray monitored from afar. \u201cShall we just taste the soup together?\u201d<\/li>\n<li><strong>Look for what blocks.<\/strong> \u201cIt doesn&#8217;t seem to tempt you? Would you prefer something else? Do you have pain when you chew?\u201d<\/li>\n<li><strong>Offer without forcing<\/strong> an already authorized alternative: a yogurt, a fruit, a snack later. We do not change texture or diet without instructions.<\/li>\n<li><strong>Document the fact.<\/strong> \u201cSecond meal refused today, says she is not hungry, seems tired.\u201d This triggers an evaluation, not the mention of \u201ccapricious\u201d.<\/li>\n<\/ol>\n<pee><strong>\u274c To avoid:<\/strong> \u201cYou won&#8217;t leave the table until it&#8217;s finished\u201d or making someone swallow quickly. A forced meal exposes to choking and turns a moment of pleasure into a trial.<\/pee>\n<p><!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 4 \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 --><\/p>\n<h2 id=\"dyn-s4\">4. \u201cI&#8217;m not getting up today\u201d<\/h2>\n<pee><em>He refuses to get up, turns towards the wall. Yesterday he was in the lounge with the others. This morning, nothing: \u201cleave me alone.\u201d The physiotherapist comes at 10 AM and is counting on him.<\/em><\/pee>\n<pee>What is happening: staying in bed can hide pain with the slightest movement, dizziness, a sleepless night, low morale, or a loss of meaning (\u201cwhat for?\u201d). Forcing someone to get up is both dangerous \u2014 falling, pain \u2014 and humiliating. But leaving a person in bed for a long time when they could get up worsens the loss of autonomy: the challenge is to understand this specific refusal today, without trivializing or forcing it.<\/pee>\n<ol class=\"dyn-steps\">\n<li><strong>Name what you see, without judging.<\/strong> \u201cYou don&#8217;t seem well this morning, is it different from usual?\u201d<\/li>\n<li><strong>Look for pain first.<\/strong> \u201cDoes something hurt when you move?\u201d A new refusal to get up is often a pain that is not expressed.<\/li>\n<li><strong>Offer a short and concrete goal.<\/strong> \u201cLet&#8217;s sit on the edge of the bed first, for five minutes, and see.\u201d The small step often reopens the door.<\/li>\n<li><strong>Signal if the refusal repeats<\/strong> or is accompanied by sadness, loss of appetite, or discouragement: this falls under the team and the doctor.<\/li>\n<\/ol>\n<pee><strong>\u274c To avoid:<\/strong> lifting the person \u201cfor their own good\u201d despite their clear refusal, or letting slip a \u201che&#8217;s just being difficult\u201d which closes off any search for a cause.<\/pee>\n<p><!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 CTA MILIEU \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 --><\/p>\n<div class=\"dyn-cta\">\n<h3>Moving from reflex to method<\/h3>\n<pee>These ten scenes rely on the same springs: understanding refusal, negotiating without forcing, respecting consent, transmitting accurately. The training <strong>\u201cCare Refusal: Understanding, Negotiating and Respecting\u201d<\/strong> covers them in 16 lessons, 100% online, at your own pace, with a certificate of completion. Certified Qualiopi organization.<\/pee>\n  <a class=\"dyn-btn\" href=\"https:\/\/www.dynseo.com\/en\/courses\/refusal-of-care-understanding-negotiating-and-respecting-a-gentle-and-ethical-approach-en\/\">Discover the training \u2014 90 \u20ac<\/a>\n<\/div>\n<p><!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 5 \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 --><\/p>\n<h2 id=\"dyn-s5\">5. Refused change, blocked intimate care<\/h2>\n<pee><em>You approach for the change. She tightens her legs, pushes your hands away, says \u201cno, stop.\u201d The tone rises, yet the protection has needed changing for a while. You feel caught between hygiene and respect.<\/em><\/pee>\n<pee>What is at stake: no care touches dignity and intimacy as much. Refusal is often a protective reaction \u2014 modesty, feeling of intrusion, too quick gestures, sometimes echoing past experiences. For a disoriented person, not understanding what is about to happen is enough to trigger fear. Forcing intimate care produces the most defensive gestures and damages the relationship the most durably.<\/pee>\n<ol class=\"dyn-steps\">\n<li><strong>Announce each gesture before doing it.<\/strong> \u201cI\u2019m going to lift the sheet, I\u2019ll warn you each time, let me know if I\u2019m going too fast.\u201d<\/li>\n<li><strong>Preserve intimacy.<\/strong> Closed door, body covered as much as possible, only one area uncovered at a time. Respected modesty reduces defensiveness.<\/li>\n<li><strong>Give control.<\/strong> \u201cYou can hold the towel\u201d: participating reduces the feeling of being an object of care.<\/li>\n<li><strong>If refusal persists, do not force<\/strong>: postpone for a few minutes, pass the task to a colleague if the relationship is better, and report. A repeated refusal of intimate care should be addressed as a team.<\/li>\n<\/ol>\n<pee><strong>\u274c To avoid:<\/strong> holding hands or legs to \u201cgo faster.\u201d Restraint for hygiene care is never improvised; any measure of this type falls under strict guidelines and a medical decision.<\/pee>\n<pee>To prevent this from happening again, identify and write down what calms: the suitable schedule, the accepted caregiver, the pace, the words that warn. Successful intimate care relies on a stable routine known to the entire team, much more than on the strength of the moment.<\/pee>\n<p><!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 6 \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 --><\/p>\n<h2 id=\"dyn-s6\">6. The refusal that escalates into screams<\/h2>\n<pee><em>What was a \u201cno\u201d becomes a scream, then a gesture: she bangs on the edge, raises her voice, pushes you away. The other residents turn around. Your heart races, the urge to respond strongly or to hold firm crosses your mind.<\/em><\/pee>\n<pee>What is at stake: escalation is almost always a sign of overflow \u2014 too many stimuli, a feeling of being trapped, pain, misunderstanding. The person is no longer in a state to reason: they are in a state of alert. Responding with authority, raising your voice, or continuing care adds danger to danger. The priority is no longer care, but the safety of everyone and returning to calm.<\/pee>\n<ol class=\"dyn-steps\">\n<li><strong>Stop the care, take a step back.<\/strong> Remove the constraint that fuels the crisis. The care can wait.<\/li>\n<li><strong>Lower everything: voice, pace, body.<\/strong> \u201cOkay. I\u2019m stopping. I\u2019m staying here, calm.\u201d A low and slow voice diffuses more than an argument.<\/li>\n<li><strong>Reduce the environment.<\/strong> Remove what pressures or observes, open up space, allow breathing. The <a href=\"https:\/\/www.dynseo.com\/en\/our-tools\/voice-scale\/\">voice scale<\/a> and the <a href=\"https:\/\/www.dynseo.com\/en\/our-tools\/emotion-thermometer\/\">emotion thermometer<\/a> help, when calm, to regain these references as a team.<\/li>\n<li><strong>Come back later, at another time<\/strong>, and precisely communicate the identified trigger. A described crisis is a crisis that can be prevented.<\/li>\n<\/ol>\n<pee><strong>\u274c To avoid:<\/strong> \u201cCalm down, it\u2019s nothing,\u201d holding the arm, or finishing the gesture at all costs. You cannot reason with someone who is overwhelmed: you must first calm them.<\/pee>\n<div class=\"dyn-alerte\">\n  <strong>\u26a0\ufe0f Safety first<\/strong>\n  <pee>If the situation poses an immediate danger to the person or others, ensure everyone is safe and follow your establishment&#8217;s procedure. In case of life-threatening distress, contact your country&#8217;s emergency services. Restraint and immobilization are never first-line responses: they fall under strict legal frameworks and medical decisions.<\/pee>\n<\/div>\n<p><!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 7 \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 --><\/p>\n<h2 id=\"dyn-s7\">7. \u00ab&nbsp;Not you&nbsp;\u00bb \u2014 the refusal directed at a caregiver<\/h2>\n<pee><em>\u00ab&nbsp;No, not you. I want the other one.&nbsp;\u00bb The phrase stings. Yet, you perform this care every day. It&#8217;s frustrating, a bit unfair, and the schedule doesn&#8217;t allow for swapping with the colleague every time.<\/em><\/pee>\n<pee>What\u2019s at play: this targeted refusal is almost never a personal attack, even if it feels like one. It may stem from a gesture perceived as too quick, a memory associated with your face, a preference for a specific gender for intimate care, or a need for stable references from a disoriented person. Taking it personally, justifying yourself, or insisting (\u00ab&nbsp;it&#8217;s me today, we have to deal with it&nbsp;\u00bb) turns a possible adjustment into a tug-of-war.<\/pee>\n<ol class=\"dyn-steps\">\n<li><strong>Don&#8217;t take it personally<\/strong>&nbsp;: welcome it. \u00ab&nbsp;Alright, I hear you. Today it&#8217;s me who is here, we will take our time.&nbsp;\u00bb<\/li>\n<li><strong>Look for what \u201cthe other\u201d does differently.<\/strong> Sometimes it&#8217;s a reproducible detail: she warms the water, she gives a warning beforehand, she takes two extra minutes.<\/li>\n<li><strong>Pass the baton when possible and relevant<\/strong>, especially for intimate care&nbsp;: respecting a preference is not giving in to a whim.<\/li>\n<li><strong>Communicate without judgment<\/strong>&nbsp;: \u00ab&nbsp;Accepts morning care better with a caregiver who announces each action.&nbsp;\u00bb It&#8217;s a useful guideline, not a note about you.<\/li>\n<\/ol>\n<pee><strong>\u274c To avoid&nbsp;:<\/strong> \u00ab&nbsp;You have no choice&nbsp;\u00bb or retaliating with offense. The targeted refusal is valuable information about what soothes the person&nbsp;: to be listened to, not crushed.<\/pee>\n<p><!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 8 \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 --><\/p>\n<h2 id=\"dyn-s8\">8. The refusal without words<\/h2>\n<pee><em>He doesn&#8217;t speak, or no longer does. As you approach, he stiffens, turns his head, pushes away the spoon or glove. No \u00ab&nbsp;no&nbsp;\u00bb spoken \u2014 but his whole body says it. You&#8217;re not sure you&#8217;re reading it correctly.<\/em><\/pee>\n<pee>What\u2019s at play: for a person with autism, aphasia after a Stroke, or someone very advanced in a neuro-evolving disease, refusal is expressed through the body and behavior, not through words. Stiffness, withdrawal, agitation, screams, fleeing gestures are words. Not reading them risks forcing without intention. Moving too quickly, arriving unannounced, or multiplying verbal instructions saturates a person who precisely needs time and a single clear channel.<\/pee>\n<ol class=\"dyn-steps\">\n<li><strong>Slow down and announce visually.<\/strong> Show the object, mime the gesture, let the person touch it first. The visual channel works when words do not.<\/li>\n<li><strong>One instruction at a time<\/strong>, short, in the order of execution, with a response time of at least a few seconds.<\/li>\n<li><strong>Rely on appropriate supports.<\/strong> Pictograms, image sequences, or the <a href=\"https:\/\/www.dynseo.com\/mon-dico-une-application-pour-favoriser-la-communication\/\">MY DICTIONARY<\/a> app to give a voice to the non-verbal&nbsp;; the <a href=\"https:\/\/www.dynseo.com\/en\/our-tools\/conversation-cards\/\">conversation cards<\/a> and the <a href=\"https:\/\/www.dynseo.com\/en\/our-tools\/facial-expression-decoder\/\">facial expression decoder<\/a> help practice reading these signals.<\/li>\n<li><strong>Identify signs of calming as well as refusal<\/strong> and communicate them&nbsp;: \u00ab&nbsp;accepts care when shown the glove first&nbsp;\u00bb.<\/li>\n<\/ol>\n<pee><strong>\u274c To avoid&nbsp;:<\/strong> concluding \u00ab&nbsp;he understands nothing&nbsp;\u00bb or continuing the gesture despite a body that says no. A non-verbal refusal remains a refusal&nbsp;: it should be respected like a refusal spoken aloud.<\/pee>\n<pee>To prevent these blockages, establish stable rituals and a consistent mode of communication from one professional to another&nbsp;: same pictograms, same visual announcements, same order of gestures. Predictability is, for a non-verbal person, the primary source of security and thus cooperation.<\/pee>\n<p><!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 9 \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 --><\/p>\n<h2 id=\"dyn-s9\">9. The young person who refuses in an institution<\/h2>\n<pee><em>In a specialized educational institution, at the school infirmary, or during an adapted stay&nbsp;: a child or adolescent shuts down at the moment of care \u2014 a bandage, a temperature check, assistance to the toilet. He screams, hides, or freezes, suddenly very small.<\/em><\/pee>\n<pee>What\u2019s at play: for a young person, refusal often expresses fear much more than opposition \u2014 fear of pain, of the unknown, of the white coat, of a past gesture that hurt once. The tone must remain protective and age-appropriate, never threatening or pressing. A child who is rushed learns to fear care&nbsp;; a child who is reassured learns that he can trust. Any sign of prolonged suffering, physical or psychological, should be reported to the doctor or psychologist.<\/pee>\n<ol class=\"dyn-steps\">\n<li><strong>Get down to their level<\/strong> and tell the truth, simply. \u00ab&nbsp;I\u2019m going to check your knee. It doesn\u2019t hurt, and I\u2019ll warn you before I touch.&nbsp;\u00bb<\/li>\n<li><strong>Give a role and a choice.<\/strong> \u00ab&nbsp;Do you want to hold the bandage? Shall we count to three together?&nbsp;\u00bb Control reassures.<\/li>\n<li><strong>Allow a comfort item, the presence of a familiar adult<\/strong>, a break. The time given is rarely time wasted.<\/li>\n<li><strong>Never establish a power dynamic or blackmail.<\/strong> If the care is not urgent, postpone, reassure, and communicate to prepare for next time with the team.<\/li>\n<\/ol>\n<pee><strong>\u274c To avoid&nbsp;:<\/strong> \u00ab&nbsp;If you don&#8217;t stay still\u2026&nbsp;\u00bb, holding forcefully or saying \u00ab&nbsp;it doesn\u2019t hurt&nbsp;\u00bb when it will be unpleasant. A visible lie breaks trust for all future care.<\/pee>\n<p><!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 10 \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 --><\/p>\n<h2 id=\"dyn-s10\">10. \u00ab&nbsp;Don&#8217;t force her&nbsp;\u00bb \u2014 the family opposes<\/h2>\n<pee><em>The daughter arrives during the care&nbsp;: \u00ab&nbsp;Don&#8217;t force her, she doesn&#8217;t like it, let her be.&nbsp;\u00bb The next day, another relative criticizes the opposite&nbsp;: \u00ab&nbsp;you\u2019re not stimulating her enough.&nbsp;\u00bb You are caught between the instructions and the families&#8217; perspectives.<\/em><\/pee>\n<pee>What\u2019s at play: behind a family&#8217;s intervention, there is almost always worry, guilt, sometimes an unresolved disagreement among relatives. The question of refusal also touches on the trusted person and, where applicable, advance directives&nbsp;: the legal framework of consent applies. Responding substantively in a corridor, justifying yourself, or pitting relatives against each other never works.<\/pee>\n<ol class=\"dyn-steps\">\n<li><strong>Welcome the emotion before the argument.<\/strong> \u00ab&nbsp;I understand that it\u2019s difficult to see her refuse. We are looking together for what suits her.&nbsp;\u00bb<\/li>\n<li><strong>Remind the principle, without opposing.<\/strong> \u00ab&nbsp;We do not force; we propose differently, we respect her refusal, and we communicate with the team.&nbsp;\u00bb<\/li>\n<li><strong>Offer the right framework<\/strong>&nbsp;: a time for discussion with the supervisor or doctor rather than an improvised decision between two doors.<\/li>\n<li><strong>Document the exchange.<\/strong> A family&#8217;s concern that is not communicated resurfaces later, amplified. The written note protects the person, the family, and the team.<\/li>\n<\/ol>\n<pee><strong>\u274c To avoid&nbsp;:<\/strong> \u00ab&nbsp;We decide&nbsp;\u00bb or, conversely, changing a medical instruction alone because a relative requested it. Refusal is decided with the person, within the framework set by the team and the doctor.<\/pee>\n<p><!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 R\u00c9CAPITULATIF \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 --><\/p>\n<h2 id=\"dyn-recap\">Refusal of care, what to do&nbsp;: the summary table<\/h2>\n<pee>Ten scenes, one common thread&nbsp;: seek the message behind the \u00ab&nbsp;no&nbsp;\u00bb, adjust the \u00ab&nbsp;how&nbsp;\u00bb, never force, communicate a fact. Before the table, four reflexes applicable in almost all situations.<\/pee>\n<div class=\"dyn-cards\">\n<div class=\"dyn-card\">\n    <span class=\"dyn-card__icon\">\ud83d\udd0e<\/span><\/p>\n<h3>Search for the cause<\/h3>\n<pee>A new refusal first makes one think of pain, discomfort, treatment. We observe and report before interpreting.<\/pee>\n  <\/div>\n<div class=\"dyn-card\">\n    <span class=\"dyn-card__icon\">\ud83e\udd1d<\/span><\/p>\n<h3>Negotiate how<\/h3>\n<pee>We keep the goal, we let go of the accessory: the time, the order, the portion, the person providing the care. Choice gives control.<\/pee>\n  <\/div>\n<div class=\"dyn-card\">\n    <span class=\"dyn-card__icon\">\ud83d\uded1<\/span><\/p>\n<h3>Do not force<\/h3>\n<pee>Postpone, pass the baton, come back. A forced care costs more than a postponed care: it closes the door to the next ones.<\/pee>\n  <\/div>\n<div class=\"dyn-card\">\n    <span class=\"dyn-card__icon\">\u270d\ufe0f<\/span><\/p>\n<h3>Transmit accurately<\/h3>\n<pee>A fact that is dated and located, never a label. \u201cRefuses at 4 PM, accepts at 9 AM\u201d is useful; \u201copponent\u201d is not.<\/pee>\n  <\/div>\n<\/div>\n<div class=\"dyn-tablewrap\">\n<table>\n<thead>\n<tr>\n<th>Situation<\/th>\n<th>What it often concerns<\/th>\n<th>\u2705 The reflex to have<\/th>\n<th>\u274c To avoid<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td>Morning toilet refused<\/td>\n<td>Intimacy, difficult waking, surprise<\/td>\n<td>Announce, offer a choice, negotiate the portion<\/td>\n<td>Discover and insist<\/td>\n<\/tr>\n<tr>\n<td>Pill spat out<\/td>\n<td>Pain, taste, swallowing, mistrust<\/td>\n<td>Look for the obstacle, report<\/td>\n<td>Crush in secret<\/td>\n<\/tr>\n<tr>\n<td>Meal left aside<\/td>\n<td>Pain, nausea, morale, habits<\/td>\n<td>Accompany, seek the cause, trace<\/td>\n<td>Force to eat<\/td>\n<\/tr>\n<tr>\n<td>Refusal to get up<\/td>\n<td>Pain in movement, morale, fatigue<\/td>\n<td>Look for the pain, aim for a small step<\/td>\n<td>Force to lift<\/td>\n<\/tr>\n<tr>\n<td>Change \/ intimate care blocked<\/td>\n<td>Modesty, fear, too quick gestures<\/td>\n<td>Announce each gesture, preserve intimacy<\/td>\n<td>Maintain to go fast<\/td>\n<\/tr>\n<tr>\n<td>Refusal that escalates to screams<\/td>\n<td>Overflow, overstimulation, pain<\/td>\n<td>Stop the care, lower the voice, calm<\/td>\n<td>Raise the tone, coerce<\/td>\n<\/tr>\n<tr>\n<td>\u201cNot you\u201d<\/td>\n<td>Felt gesture, preference, reference points<\/td>\n<td>Welcome, seek the detail, relay<\/td>\n<td>Justify, insist<\/td>\n<\/tr>\n<tr>\n<td>Refusal without words<\/td>\n<td>Autism, aphasia, advanced disorders<\/td>\n<td>Show, slow down, visual supports<\/td>\n<td>Conclude \u201che understands nothing\u201d<\/td>\n<\/tr>\n<tr>\n<td>Young person who refuses<\/td>\n<td>Fear of the unknown, of pain<\/td>\n<td>Get to their level, reassure, give a role<\/td>\n<td>Blackmail, force, lie<\/td>\n<\/tr>\n<tr>\n<td>\u201cDo not force her\u201d<\/td>\n<td>Worry, family guilt<\/td>\n<td>Welcome, remind the framework, trace<\/td>\n<td>Oppose, decide alone<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<div class=\"dyn-note\">\n  <strong>\u2139\ufe0f Refusal is a right<\/strong>\n  <pee>In France, free and informed consent to care \u2014 and therefore the possibility to refuse it \u2014 is enshrined in the Public Health Code. A refusal is sought, explained, traced, and respected: it cannot be circumvented. These guidelines do not replace the protocols of your establishment or the opinion of the healthcare professional for any individual situation.<\/pee>\n<\/div>\n<p><!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 SERIES \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 --><\/p>\n<h2>To go further<\/h2>\n<pee>These ten scenes show the \u201cwhat to do\u201d in the moment. To sustainably anchor a response to <strong>refusal of care<\/strong> \u2014 what to do not only on the same day but over time and as a team \u2014 three deepening articles from the same series extend this article.<\/pee>\n<div class=\"dyn-serie\">\n  <a href=\"#comprendre\"><span>Background Guide<\/span>Refusal of care: the complete guide to understanding what is at stake<\/a><br \/>\n  <a href=\"#activites\"><span>Toolbox<\/span>Activities, resources, and concrete arrangements to implement<\/a><br \/>\n  <a href=\"#posture\"><span>Professional posture<\/span>Posture, teamwork, and skill development in the face of refusal<\/a><br \/>\n  <a href=\"#formation\"><span>The training<\/span>Program, content, and who the &#8220;Refusal of care&#8221; training is for<\/a>\n<\/div>\n<pee>On the side of free resources, several DYNSEO tools directly serve these situations: the <a href=\"https:\/\/www.dynseo.com\/en\/our-tools\/choice-wheel-dynseo-training-tools\/\">choice wheel<\/a> to empower the person, the <a href=\"https:\/\/www.dynseo.com\/en\/our-tools\/emotion-thermometer\/\">emotion thermometer<\/a> to detect the rise before the crisis, and the entire <a href=\"https:\/\/www.dynseo.com\/en\/our-tools\/\">tool catalog<\/a>. To maintain the connection and stimulation on a daily basis, the application <a href=\"https:\/\/www.dynseo.com\/en\/brain-games-apps\/scarlett-brain-games-for-seniors\/\">SCARLETT<\/a> supports elderly people, including in the context of Alzheimer&#8217;s disease or Parkinson&#8217;s, while <a href=\"https:\/\/www.dynseo.com\/en\/brain-games-apps\/clint-brain-games-for-adults\/\">CLINT<\/a> is aimed at adults in mental health or after a Stroke. Finally, the <a href=\"https:\/\/www.dynseo.com\/en\/our-tests\/\">cognitive tests<\/a> help better assess a person&#8217;s abilities before adapting care.<\/pee>\n<p><!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 FAQ \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 --><\/p>\n<h2 id=\"dyn-faq\">Frequently Asked Questions<\/h2>\n<div class=\"dyn-faq\">\n<h3>Are we allowed to refuse care&nbsp;?<\/h3>\n<pee>Yes. In France, free and informed consent is a principle enshrined in the Public Health Code&nbsp;: an informed person can refuse care, even when this refusal seems unreasonable to the professional. The team&#8217;s role is then to inform clearly, to seek the reason for the refusal, to propose alternatives, and to document the decision. For a person whose discernment is impaired, the trusted person, advance directives, and medical advice come into play. Forcing care outside of any framework exposes the person and engages the professional&#8217;s responsibility&nbsp;: the refusal must be respected, it cannot be circumvented.<\/pee>\n<h3>Refusal of care, what to do in case of a vital emergency&nbsp;?<\/h3>\n<pee>The situation changes in nature. In the face of a vital distress \u2014 loss of consciousness, major respiratory difficulty, hemorrhage, signs suggesting a Stroke \u2014 we ensure the person&#8217;s safety, apply the emergency procedure of the establishment, and contact the emergency services of your country. The emergency takes precedence over the analysis of the refusal. Outside of vital emergencies, however, a refusal needs to be addressed&nbsp;: we do not turn every opposition into an emergency situation to justify overriding it. In case of doubt about the urgent nature, we promptly consult the nurse, supervisor, or doctor.<\/pee>\n<h3>How to avoid forcing without &#8220;giving up&#8221; on care&nbsp;?<\/h3>\n<pee>Not forcing is not giving up. It is shifting the effort from &#8220;if&#8221; to &#8220;how&#8221;&nbsp;: postponing to a better moment, breaking the care into small steps, offering a choice, changing the caregiver, adapting the environment. A postponed and accepted care is better than a forced care that will lead to refusal the next day. When the refusal persists despite these adjustments, we do not persist alone&nbsp;: we precisely communicate what has been attempted and bring the question to the team. It is this combination \u2014 flexibility in form, insistence on the objective, collective decision-making \u2014 that protects both the person and the quality of care.<\/pee>\n<h3>What to note in communications after a refusal&nbsp;?<\/h3>\n<pee>A dated, located, and reproducible fact, not an interpretation. \u201c&nbsp;Refusal of bathing at 7:40 AM, accepted at 9 AM after coffee&nbsp;\u201d is actionable&nbsp;: it guides and allows for team decision-making. \u201c&nbsp;Opposing&nbsp;\u201d or \u201c&nbsp;fickle&nbsp;\u201d adds nothing and misleads colleagues for months. Also note what worked&nbsp;: the time, the wording, the caregiver, the arrangement. This positive information is as valuable as the refusal itself, as it makes the next care possible. A useful communication describes an observable behavior, never a personality label.<\/pee>\n<h3>How to protect the team against repeated refusals&nbsp;?<\/h3>\n<pee>A recurring refusal is exhausting&nbsp;: feelings of failure, tension, sometimes guilt. The first lever is to break out of isolation&nbsp;: discuss it in meetings, collectively decide on the level of assistance and instructions, write down what works so that everyone applies the same approach, including substitutes. The second is to remember that a respected refusal is not a professional fault&nbsp;: it is often a sign of quality support. Training finally provides a common vocabulary and shared benchmarks, which calms the team as well as the relationship with the supported person.<\/pee>\n<\/div>\n<div class=\"dyn-note\">\n  <strong>\u2139\ufe0f Information and not medical advice<\/strong>\n  <pee>This article provides general professional guidelines. It does not replace the protocols of your establishment, individual prescriptions, or the opinion of the care team. For any diagnosis, prognosis, or therapeutic decision, refer to the healthcare professional and your supervision. In case of emergency, contact the emergency services of your country.<\/pee>\n<\/div>\n<p><!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 CTA FINAL \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 --><\/p>\n<div class=\"dyn-cta\">\n<h3>In the face of refusal of care, know what to do \u2014 and why<\/h3>\n<pee>From morning hygiene to silent refusals, knowing <strong>what to do in the face of a refusal of care<\/strong> is learned: understanding what is at stake, negotiating without forcing, respecting consent, communicating clearly. The training <strong>\u201cRefusal of care: understanding, negotiating, and respecting \u2014 a gentle and ethical approach\u201d<\/strong> brings all this together in 16 lessons, 100% online, unlimited access, with a certificate of completion. Certified organization Qualiopi No. 11757351875.<\/pee>\n  <a class=\"dyn-btn\" href=\"https:\/\/www.dynseo.com\/en\/courses\/refusal-of-care-understanding-negotiating-and-respecting-a-gentle-and-ethical-approach-en\/\">Discover the training \u2014 90 \u20ac<\/a>\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\" 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situations difficiles du quotidien et comment y r\u00e9pondre\",\n      \"inLanguage\": \"fr\",\n      \"author\": {\n        \"@type\": \"Organization\",\n        \"name\": \"DYNSEO\",\n        \"url\": \"https:\/\/www.dynseo.com\/\"\n      },\n      \"publisher\": {\n        \"@type\": \"Organization\",\n        \"name\": \"DYNSEO\",\n        \"url\": \"https:\/\/www.dynseo.com\/\"\n      },\n      \"image\": \"https:\/\/www.dynseo.com\/wp-content\/uploads\/2026\/04\/Autisme-en-etablissement-Accompagnement-Global-161-pdf.jpg\"\n    },\n    {\n      \"@type\": \"FAQPage\",\n      \"mainEntity\": [\n        {\n          \"@type\": \"Question\",\n          \"name\": \"A-t-on le droit de refuser un soin ?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"Oui. En France, le consentement libre et \u00e9clair\u00e9 est un principe inscrit dans le Code de la sant\u00e9 publique : une personne inform\u00e9e peut refuser un soin, m\u00eame quand ce refus para\u00eet d\u00e9raisonnable au professionnel. Le r\u00f4le de l'\u00e9quipe est alors d'informer clairement, de rechercher la cause du refus, de proposer autrement et de tracer la d\u00e9cision. Chez une personne dont le discernement est alt\u00e9r\u00e9, la personne de confiance, les directives anticip\u00e9es et l'avis m\u00e9dical entrent en jeu. Forcer un soin en dehors de tout cadre expose la personne et engage la responsabilit\u00e9 du professionnel : le refus se respecte, il ne se contourne pas.\"\n          }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Refus de soins, que faire quand il y a urgence vitale ?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"La situation change de nature. Devant une d\u00e9tresse vitale \u2014 perte de connaissance, difficult\u00e9 respiratoire majeure, h\u00e9morragie, signes \u00e9voquant un AVC \u2014, on met la personne en s\u00e9curit\u00e9, on applique la proc\u00e9dure d'urgence de l'\u00e9tablissement et on contacte les services d'urgence de votre pays. L'urgence prime sur l'analyse du refus. En dehors de l'urgence vitale, en revanche, un refus se travaille : on ne transforme pas chaque opposition en situation d'urgence pour justifier de passer outre. En cas de doute sur le caract\u00e8re urgent, on sollicite sans attendre l'infirmi\u00e8re, le cadre ou le m\u00e9decin.\"\n          }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Comment ne pas forcer sans pour autant \u00ab laisser tomber \u00bb le soin ?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"Ne pas forcer n'est pas renoncer. C'est d\u00e9placer l'effort du \u00ab si \u00bb vers le \u00ab comment \u00bb : reporter \u00e0 un meilleur moment, d\u00e9couper le soin en petites \u00e9tapes, proposer un choix, changer d'intervenant, adapter l'environnement. Un soin report\u00e9 et accept\u00e9 vaut mieux qu'un soin arrach\u00e9 qui fera refuser le lendemain. Quand le refus persiste malgr\u00e9 ces ajustements, on ne s'obstine pas seul : on transmet pr\u00e9cis\u00e9ment ce qui a \u00e9t\u00e9 tent\u00e9 et on porte la question en \u00e9quipe. C'est cette combinaison \u2014 souplesse sur la forme, exigence sur l'objectif, d\u00e9cision collective \u2014 qui prot\u00e8ge \u00e0 la fois la personne et la qualit\u00e9 du soin.\"\n          }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Que noter dans les transmissions apr\u00e8s un refus ?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"Un fait dat\u00e9, situ\u00e9 et reproductible, pas une interpr\u00e9tation. \u00ab Refus de la toilette \u00e0 7 h 40, accept\u00e9e \u00e0 9 h apr\u00e8s le caf\u00e9 \u00bb est exploitable : cela oriente et permet de d\u00e9cider en \u00e9quipe. \u00ab Opposant \u00bb ou \u00ab capricieuse \u00bb n'apporte rien et suit la personne pendant des mois en orientant \u00e0 tort les coll\u00e8gues suivants. Notez aussi ce qui a fonctionn\u00e9 : l'heure, la formulation, l'intervenant, l'am\u00e9nagement. Ces informations positives valent autant que le refus lui-m\u00eame, car elles rendent le prochain soin possible. Une transmission utile d\u00e9crit un comportement observable, jamais une \u00e9tiquette de personnalit\u00e9.\"\n          }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Comment prot\u00e9ger l'\u00e9quipe face aux refus r\u00e9p\u00e9t\u00e9s ?\",\n          \"acceptedAnswer\": {\n            \"@type\": \"Answer\",\n            \"text\": \"Un refus qui revient use : sentiment d'\u00e9chec, tension, parfois culpabilit\u00e9. Le premier levier est de sortir de l'isolement : en parler en r\u00e9union, d\u00e9cider collectivement du niveau d'aide et des consignes, \u00e9crire ce qui marche pour que chacun applique la m\u00eame chose, y compris les rempla\u00e7ants. Le deuxi\u00e8me est de se rappeler qu'un refus respect\u00e9 n'est pas une faute professionnelle : c'est souvent le signe d'un accompagnement de qualit\u00e9. Se former donne enfin un vocabulaire commun et des rep\u00e8res partag\u00e9s, ce qui apaise l'\u00e9quipe autant que la relation avec la personne accompagn\u00e9e.\"\n          }\n        }\n      ]\n    }\n  ]\n}\n<\/script>\n<div class=\"dbi-art-5e4859\">\n<!--\n\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\nDYNSEO \u2014 SEO\/GEO ARTICLE TEMPLATE \u00b7 v1.0\nDo not modify class names: the script generer-articles.py\nand all previously published articles depend on it.\n\nThe script generer-articles.py injects, in order: the colored header,\nthe training or tool box, the written body, then the structured data.\n\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n-->\n\n<div class=\"dyn-article\">\n\n\n\n<header class=\"dyn-pagehead dyn-pagehead--eau\">\n  <span class=\"dyn-pagehead__cat\">Professionals \u00b7 Behavioral disorders<\/span>\n  <h1>Refusal of care: 10 difficult everyday situations and how to respond<\/h1>\n  <p class=\"dyn-pagehead__lead\">Refusal of care almost never occurs in major decisions. It happens in ordinary moments: a glove offered at the edge of the bed, a pill placed in the palm of the hand, a protection to change on a tired evening, a child curling up when approached. The recurring question, the same for the caregiver in a Nursing home, the educator in a specialized institution, or the nurse at home, can be summed up in three words: <strong>refusal of care, what to do<\/strong>? Not in theory, but in the moment, with the person in front of you and the schedule pressing.<\/p>\n  <ul class=\"dyn-pagehead__meta\">\n    <li>\u23f1\ufe0f 18 min read<\/li>\n    <li>\ud83d\udc65 For professionals<\/li>\n    <li>\ud83d\udd04 Updated in August 2026<\/li>\n  <\/ul>\n<\/header>\n\n<aside class=\"dyn-hero\" aria-label=\"Training presented in this article\">\n  <div class=\"dyn-hero__grid\">\n    <div class=\"dyn-hero__media\"><a href=\"https:\/\/www.dynseo.com\/courses\/refus-de-soins-comprendre-negocier-et-respecter-une-approche-douce-et-ethique\/\"><img src=\"https:\/\/www.dynseo.com\/wp-content\/uploads\/2026\/04\/autism-en-etablissement-Accompagnement-Global-161-pdf.jpg\" alt=\"DYNSEO Training 'Refusal of care: understanding, negotiating, and respecting \u2014 a gentle and ethical approach'\" width=\"1920\" height=\"1080\" loading=\"lazy\"><\/a><\/div>\n    <div class=\"dyn-hero__body\">\n      <span class=\"dyn-hero__eyebrow\">The training related to this article<\/span>\n      <p class=\"dyn-hero__title\"><a href=\"https:\/\/www.dynseo.com\/courses\/refus-de-soins-comprendre-negocier-et-respecter-une-approche-douce-et-ethique\/\">Refusal of care: understanding, negotiating, and respecting \u2014 a gentle and ethical approach<\/a><\/p>\n      <p class=\"dyn-hero__pitch\">Everything this article explains, put into practice.<\/p>\n      <ul class=\"dyn-badges\">\n        <li>\ud83c\udfa5 5 modules \u00b7 16 lessons<\/li>\n        <li>\ud83d\udcbb 100% online<\/li>\n        <li>\u23f1\ufe0f At your own pace<\/li>\n        <li>\ud83c\udfc5 Qualiopi organization<\/li>\n        <li>\ud83c\udf0d 9 languages<\/li>\n      <\/ul>\n<div class=\"dyn-hero__actions\">\n        <a class=\"dyn-btn\" href=\"https:\/\/www.dynseo.com\/courses\/refus-de-soins-comprendre-negocier-et-respecter-une-approche-douce-et-ethique\/\">See the training<\/a>\n        <span class=\"dyn-hero__price\">90.0 \u20ac<\/span>\n      <\/div>\n    <\/div>\n  <\/div>\n<\/aside>\n\n<p>Here are ten of these situations, described as they actually occur. For each one: the scene, what is happening behind the \"no\", the spontaneous reaction that makes everything worse, and then the step-by-step response \u2014 with the exact words to say and the gestures that work. No medical protocol here: just a way to observe, to defuse, to respect, and to communicate. The rest always falls to the team and the healthcare professional.<\/p>\n\n<!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 SHORT RESPONSE (GEO) \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n<section class=\"dyn-tldr\">\n  <h2>The essentials in 30 seconds<\/h2>\n  <p>A refusal is almost never a whim. It's a message: fear, pain, fatigue, misunderstanding, or simply a need to maintain control over one's life. Responding means first seeking that message before trying to convince.<\/p>\n  <ul>\n    <li><strong>Refusal is a right<\/strong> before being a problem: consent, and thus refusal, are enshrined in law.<\/li>\n    <li><strong>Look for the cause before the solution.<\/strong> A new refusal from someone usually cooperative first suggests pain or discomfort.<\/li>\n    <li><strong>Negotiate the \"how\", not the \"if\".<\/strong> Keep the goal, let go of the rest: the time, the order, the portion, the person providing care.<\/li>\n    <li><strong>Forcing resolves the minute and damages the relationship<\/strong> \u2014 and thus all subsequent care.<\/li>\n    <li><strong>A useful transmission<\/strong> describes a dated and situated fact, never a label like \"opponent\".<\/li>\n  <\/ul>\n<\/section>\n\n<nav class=\"dyn-toc\" aria-label=\"Table of contents\">\n  <p>The 10 situations<\/p>\n  <ol>\n    <li><a href=\"#dyn-s1\">The morning wash refused<\/a><\/li>\n    <li><a href=\"#dyn-s2\">The pill spat out or pushed away<\/a><\/li>\n    <li><a href=\"#dyn-s3\">The meal left aside<\/a><\/li>\n    <li><a href=\"#dyn-s4\">\u201cI'm not getting up today\u201d<\/a><\/li>\n    <li><a href=\"#dyn-s5\">The change refused, the intimate care blocked<\/a><\/li>\n    <li><a href=\"#dyn-s6\">The refusal that escalates into screams<\/a><\/li>\n    <li><a href=\"#dyn-s7\">\u201cNot you\u201d \u2014 the refusal directed at a caregiver<\/a><\/li>\n    <li><a href=\"#dyn-s8\">The refusal without words<\/a><\/li>\n    <li><a href=\"#dyn-s9\">The young person refusing in an institution<\/a><\/li>\n    <li><a href=\"#dyn-s10\">\u201cDon't force her\u201d \u2014 the family opposes<\/a><\/li>\n    <li><a href=\"#dyn-recap\">Refusal of care, what to do: the summary table<\/a><\/li>\n    <li><a href=\"#dyn-faq\">Frequently asked questions<\/a><\/li>\n  <\/ol>\n<\/nav>\n\n<!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 1 \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n<h2 id=\"dyn-s1\">1. The morning wash refused<\/h2>\n\n<p><em>7:40 AM. You enter with the washcloth and towel, the light turned on suddenly. \u201cIt's time for the wash!\u201d She pulls the sheet up to her chin, turns her head, says no, then nothing. You have five more people before breakfast.<\/em><\/p>\n\n<p>What is happening: the wash is the most intimate care there is, and it comes at the worst cognitive moment for many people \u2014 waking up, disorientation, sometimes the pain of the first movements. The \u201cno\u201d rarely says \u201cnever\u201d: it says \u201cnot like this, not now, not surprised in my sleep\u201d. The spontaneous reaction that makes everything worse is to insist, to pull back the sheet, or to return with two people: the person feels forced and the refusal solidifies for the week.<\/p>\n\n<ol class=\"dyn-steps\">\n  <li><strong>Knock, announce, leave some time.<\/strong> \u201cHello Madam, it's Julie. I'm going to open the curtain a little, let's take our time.\u201d We enter into a relationship, not into a room.<\/li>\n  <li><strong>Offer a choice, not an order.<\/strong> \u201cShall we start with the face or the hands?\u201d The choice gives control back to the person without taking away from the goal.<\/li>\n  <li><strong>Negotiate the portion.<\/strong> An upper body wash accepted today is better than a full wash imposed that will lead to refusal tomorrow.<\/li>\n  <li><strong>Explicitly postpone<\/strong> if the refusal holds: \u201cOkay, I'll come back in twenty minutes, after your coffee.\u201d An announced postponement is not a failure, it's an agreement.<\/li>\n<\/ol>\n\n<p><strong>\u274c To avoid:<\/strong> \u201cYou have to wash well, come on, let's go\u201d while uncovering the person. You don't win a wash by force without losing the trust that made it possible.<\/p>\n\n<p>To prevent this from happening again, note the time and conditions that work: if the wash consistently happens after coffee, that's an organizational fact to bring up in meetings, not a preference to reinvent every morning.<\/p>\n\n<!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 2 \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n<h2 id=\"dyn-s2\">2. The pill spat out or pushed away<\/h2>\n\n<p><em>You extend the evening pillbox. She looks at the pills, presses her lips together, pushes your hand away. Everything went down without a word yesterday. A colleague whispers to you: \u201cCrush them in the applesauce, it'll go down.\u201d<\/em><\/p>\n\n<p>What is happening: a new medication refusal, from someone who took everything the day before, must first seek a cause. The High Authority of Health reminds us that in the face of any change in behavior, we first look for a somatic cause: pain, sores, bad taste, difficulty swallowing, a pill too big, distrust related to a confused state. The refusal can also be a lucid decision that must be heard. Crushing a treatment in secret can be dangerous (some forms cannot be crushed) and deprives the person of their consent.<\/p>\n\n<ol class=\"dyn-steps\">\n  <li><strong>Look for the concrete obstacle.<\/strong> \u201cDoes it bother you to swallow? Is it the taste? Do you have pain somewhere?\u201d Often the answer is there.<\/li>\n  <li><strong>Don't crush anything on your own initiative.<\/strong> Modifying a galenic form falls under a prescription and pharmaceutical advice, never a hallway arrangement.<\/li>\n  <li><strong>Offer a simple alternative<\/strong> already planned: a little water, another nearby moment, without concealment.<\/li>\n  <li><strong>Report and document.<\/strong> \u201cRefusal of the evening treatment, pills pushed away, complains of throat pain.\u201d The nurse and doctor decide on the next steps.<\/li>\n<\/ol>\n\n<p><strong>\u274c To avoid:<\/strong> hiding the medication in food without explicit prescription. It's a violation of consent, sometimes a risk, and it destroys trust the day the person realizes it.<\/p>\n\n<!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 3 \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n<h2 id=\"dyn-s3\">3. The meal left aside<\/h2>\n\n<p><em>Noon. The tray is untouched, the fork hasn't moved. \u201cI'm not hungry, take it away.\u201d You know she hardly ate anything at breakfast either. Service time is running out, it needs to be cleared.<\/em><\/p>\n\n<p>What is happening: a food refusal covers very different realities that cannot be sliced alone. Dental pain, swallowing disorder, nausea related to treatment, depression, grief, a dish that does not match cultural or religious habits, or simply a real absence of hunger that day. Repeated refusals and weight loss are signals for vigilance. Insisting, scolding, or forcing someone to eat only tightens and increases refusal at the next meal.<\/p>\n\n<ol class=\"dyn-steps\">\n  <li><strong>Stay, sit for a minute.<\/strong> A tray accompanied goes down better than a tray monitored from afar. \u201cShall we just taste the soup together?\u201d<\/li>\n  <li><strong>Look for what blocks.<\/strong> \u201cIt doesn't seem to tempt you? Would you prefer something else? Do you have pain when you chew?\u201d<\/li>\n  <li><strong>Offer without forcing<\/strong> an already authorized alternative: a yogurt, a fruit, a snack later. We do not change texture or diet without instructions.<\/li>\n  <li><strong>Document the fact.<\/strong> \u201cSecond meal refused today, says she is not hungry, seems tired.\u201d This triggers an evaluation, not the mention of \u201ccapricious\u201d.<\/li>\n<\/ol>\n\n<p><strong>\u274c To avoid:<\/strong> \u201cYou won't leave the table until it's finished\u201d or making someone swallow quickly. A forced meal exposes to choking and turns a moment of pleasure into a trial.<\/p>\n\n<!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 4 \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n<h2 id=\"dyn-s4\">4. \u201cI'm not getting up today\u201d<\/h2>\n\n<p><em>He refuses to get up, turns towards the wall. Yesterday he was in the lounge with the others. This morning, nothing: \u201cleave me alone.\u201d The physiotherapist comes at 10 AM and is counting on him.<\/em><\/p>\n\n<p>What is happening: staying in bed can hide pain with the slightest movement, dizziness, a sleepless night, low morale, or a loss of meaning (\u201cwhat for?\u201d). Forcing someone to get up is both dangerous \u2014 falling, pain \u2014 and humiliating. But leaving a person in bed for a long time when they could get up worsens the loss of autonomy: the challenge is to understand this specific refusal today, without trivializing or forcing it.<\/p>\n\n<ol class=\"dyn-steps\">\n  <li><strong>Name what you see, without judging.<\/strong> \u201cYou don't seem well this morning, is it different from usual?\u201d<\/li>\n  <li><strong>Look for pain first.<\/strong> \u201cDoes something hurt when you move?\u201d A new refusal to get up is often a pain that is not expressed.<\/li>\n  <li><strong>Offer a short and concrete goal.<\/strong> \u201cLet's sit on the edge of the bed first, for five minutes, and see.\u201d The small step often reopens the door.<\/li>\n  <li><strong>Signal if the refusal repeats<\/strong> or is accompanied by sadness, loss of appetite, or discouragement: this falls under the team and the doctor.<\/li>\n<\/ol>\n\n<p><strong>\u274c To avoid:<\/strong> lifting the person \u201cfor their own good\u201d despite their clear refusal, or letting slip a \u201che's just being difficult\u201d which closes off any search for a cause.<\/p>\n\n<!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 CTA MILIEU \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n<div class=\"dyn-cta\">\n  <h3>Moving from reflex to method<\/h3>\n  <p>These ten scenes rely on the same springs: understanding refusal, negotiating without forcing, respecting consent, transmitting accurately. The training <strong>\u201cCare Refusal: Understanding, Negotiating and Respecting\u201d<\/strong> covers them in 16 lessons, 100% online, at your own pace, with a certificate of completion. Certified Qualiopi organization.<\/p>\n  <a class=\"dyn-btn\" href=\"https:\/\/www.dynseo.com\/courses\/refus-de-soins-comprendre-negocier-et-respecter-une-approche-douce-et-ethique\/\">Discover the training \u2014 90 \u20ac<\/a>\n<\/div>\n\n<!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 5 \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n<h2 id=\"dyn-s5\">5. Refused change, blocked intimate care<\/h2>\n\n<p><em>You approach for the change. She tightens her legs, pushes your hands away, says \u201cno, stop.\u201d The tone rises, yet the protection has needed changing for a while. You feel caught between hygiene and respect.<\/em><\/p>\n\n<p>What is at stake: no care touches dignity and intimacy as much. Refusal is often a protective reaction \u2014 modesty, feeling of intrusion, too quick gestures, sometimes echoing past experiences. For a disoriented person, not understanding what is about to happen is enough to trigger fear. Forcing intimate care produces the most defensive gestures and damages the relationship the most durably.<\/p>\n\n<ol class=\"dyn-steps\">\n  <li><strong>Announce each gesture before doing it.<\/strong> \u201cI\u2019m going to lift the sheet, I\u2019ll warn you each time, let me know if I\u2019m going too fast.\u201d<\/li>\n  <li><strong>Preserve intimacy.<\/strong> Closed door, body covered as much as possible, only one area uncovered at a time. Respected modesty reduces defensiveness.<\/li>\n  <li><strong>Give control.<\/strong> \u201cYou can hold the towel\u201d: participating reduces the feeling of being an object of care.<\/li>\n  <li><strong>If refusal persists, do not force<\/strong>: postpone for a few minutes, pass the task to a colleague if the relationship is better, and report. A repeated refusal of intimate care should be addressed as a team.<\/li>\n<\/ol>\n\n<p><strong>\u274c To avoid:<\/strong> holding hands or legs to \u201cgo faster.\u201d Restraint for hygiene care is never improvised; any measure of this type falls under strict guidelines and a medical decision.<\/p>\n\n<p>To prevent this from happening again, identify and write down what calms: the suitable schedule, the accepted caregiver, the pace, the words that warn. Successful intimate care relies on a stable routine known to the entire team, much more than on the strength of the moment.<\/p>\n\n<!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 6 \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n<h2 id=\"dyn-s6\">6. The refusal that escalates into screams<\/h2>\n\n<p><em>What was a \u201cno\u201d becomes a scream, then a gesture: she bangs on the edge, raises her voice, pushes you away. The other residents turn around. Your heart races, the urge to respond strongly or to hold firm crosses your mind.<\/em><\/p>\n\n<p>What is at stake: escalation is almost always a sign of overflow \u2014 too many stimuli, a feeling of being trapped, pain, misunderstanding. The person is no longer in a state to reason: they are in a state of alert. Responding with authority, raising your voice, or continuing care adds danger to danger. The priority is no longer care, but the safety of everyone and returning to calm.<\/p>\n\n<ol class=\"dyn-steps\">\n  <li><strong>Stop the care, take a step back.<\/strong> Remove the constraint that fuels the crisis. The care can wait.<\/li>\n  <li><strong>Lower everything: voice, pace, body.<\/strong> \u201cOkay. I\u2019m stopping. I\u2019m staying here, calm.\u201d A low and slow voice diffuses more than an argument.<\/li>\n  <li><strong>Reduce the environment.<\/strong> Remove what pressures or observes, open up space, allow breathing. The <a href=\"https:\/\/www.dynseo.com\/nos-outils\/echelle-de-la-voix\/\">voice scale<\/a> and the <a href=\"https:\/\/www.dynseo.com\/nos-outils\/thermometre-des-emotions\/\">emotion thermometer<\/a> help, when calm, to regain these references as a team.<\/li>\n  <li><strong>Come back later, at another time<\/strong>, and precisely communicate the identified trigger. A described crisis is a crisis that can be prevented.<\/li>\n<\/ol>\n\n<p><strong>\u274c To avoid:<\/strong> \u201cCalm down, it\u2019s nothing,\u201d holding the arm, or finishing the gesture at all costs. You cannot reason with someone who is overwhelmed: you must first calm them.<\/p>\n<div class=\"dyn-alerte\">\n  <strong>\u26a0\ufe0f Safety first<\/strong>\n  <p>If the situation poses an immediate danger to the person or others, ensure everyone is safe and follow your establishment's procedure. In case of life-threatening distress, contact your country's emergency services. Restraint and immobilization are never first-line responses: they fall under strict legal frameworks and medical decisions.<\/p>\n<\/div>\n\n<!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 7 \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n<h2 id=\"dyn-s7\">7. \u00ab&nbsp;Not you&nbsp;\u00bb \u2014 the refusal directed at a caregiver<\/h2>\n\n<p><em>\u00ab&nbsp;No, not you. I want the other one.&nbsp;\u00bb The phrase stings. Yet, you perform this care every day. It's frustrating, a bit unfair, and the schedule doesn't allow for swapping with the colleague every time.<\/em><\/p>\n\n<p>What\u2019s at play: this targeted refusal is almost never a personal attack, even if it feels like one. It may stem from a gesture perceived as too quick, a memory associated with your face, a preference for a specific gender for intimate care, or a need for stable references from a disoriented person. Taking it personally, justifying yourself, or insisting (\u00ab&nbsp;it's me today, we have to deal with it&nbsp;\u00bb) turns a possible adjustment into a tug-of-war.<\/p>\n\n<ol class=\"dyn-steps\">\n  <li><strong>Don't take it personally<\/strong>&nbsp;: welcome it. \u00ab&nbsp;Alright, I hear you. Today it's me who is here, we will take our time.&nbsp;\u00bb<\/li>\n  <li><strong>Look for what \u201cthe other\u201d does differently.<\/strong> Sometimes it's a reproducible detail: she warms the water, she gives a warning beforehand, she takes two extra minutes.<\/li>\n  <li><strong>Pass the baton when possible and relevant<\/strong>, especially for intimate care&nbsp;: respecting a preference is not giving in to a whim.<\/li>\n  <li><strong>Communicate without judgment<\/strong>&nbsp;: \u00ab&nbsp;Accepts morning care better with a caregiver who announces each action.&nbsp;\u00bb It's a useful guideline, not a note about you.<\/li>\n<\/ol>\n\n<p><strong>\u274c To avoid&nbsp;:<\/strong> \u00ab&nbsp;You have no choice&nbsp;\u00bb or retaliating with offense. The targeted refusal is valuable information about what soothes the person&nbsp;: to be listened to, not crushed.<\/p>\n\n<!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 8 \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n<h2 id=\"dyn-s8\">8. The refusal without words<\/h2>\n\n<p><em>He doesn't speak, or no longer does. As you approach, he stiffens, turns his head, pushes away the spoon or glove. No \u00ab&nbsp;no&nbsp;\u00bb spoken \u2014 but his whole body says it. You're not sure you're reading it correctly.<\/em><\/p>\n\n<p>What\u2019s at play: for a person with autism, aphasia after a Stroke, or someone very advanced in a neuro-evolving disease, refusal is expressed through the body and behavior, not through words. Stiffness, withdrawal, agitation, screams, fleeing gestures are words. Not reading them risks forcing without intention. Moving too quickly, arriving unannounced, or multiplying verbal instructions saturates a person who precisely needs time and a single clear channel.<\/p>\n\n<ol class=\"dyn-steps\">\n  <li><strong>Slow down and announce visually.<\/strong> Show the object, mime the gesture, let the person touch it first. The visual channel works when words do not.<\/li>\n  <li><strong>One instruction at a time<\/strong>, short, in the order of execution, with a response time of at least a few seconds.<\/li>\n  <li><strong>Rely on appropriate supports.<\/strong> Pictograms, image sequences, or the <a href=\"https:\/\/www.dynseo.com\/mon-dico-une-application-pour-favoriser-la-communication\/\">MY DICTIONARY<\/a> app to give a voice to the non-verbal&nbsp;; the <a href=\"https:\/\/www.dynseo.com\/nos-outils\/cartes-de-conversation\/\">conversation cards<\/a> and the <a href=\"https:\/\/www.dynseo.com\/nos-outils\/decodeur-dexpressions-faciales\/\">facial expression decoder<\/a> help practice reading these signals.<\/li>\n  <li><strong>Identify signs of calming as well as refusal<\/strong> and communicate them&nbsp;: \u00ab&nbsp;accepts care when shown the glove first&nbsp;\u00bb.<\/li>\n<\/ol>\n\n<p><strong>\u274c To avoid&nbsp;:<\/strong> concluding \u00ab&nbsp;he understands nothing&nbsp;\u00bb or continuing the gesture despite a body that says no. A non-verbal refusal remains a refusal&nbsp;: it should be respected like a refusal spoken aloud.<\/p>\n\n<p>To prevent these blockages, establish stable rituals and a consistent mode of communication from one professional to another&nbsp;: same pictograms, same visual announcements, same order of gestures. Predictability is, for a non-verbal person, the primary source of security and thus cooperation.<\/p>\n\n<!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 9 \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n<h2 id=\"dyn-s9\">9. The young person who refuses in an institution<\/h2>\n\n<p><em>In a specialized educational institution, at the school infirmary, or during an adapted stay&nbsp;: a child or adolescent shuts down at the moment of care \u2014 a bandage, a temperature check, assistance to the toilet. He screams, hides, or freezes, suddenly very small.<\/em><\/p>\n\n<p>What\u2019s at play: for a young person, refusal often expresses fear much more than opposition \u2014 fear of pain, of the unknown, of the white coat, of a past gesture that hurt once. The tone must remain protective and age-appropriate, never threatening or pressing. A child who is rushed learns to fear care&nbsp;; a child who is reassured learns that he can trust. Any sign of prolonged suffering, physical or psychological, should be reported to the doctor or psychologist.<\/p>\n\n<ol class=\"dyn-steps\">\n  <li><strong>Get down to their level<\/strong> and tell the truth, simply. \u00ab&nbsp;I\u2019m going to check your knee. It doesn\u2019t hurt, and I\u2019ll warn you before I touch.&nbsp;\u00bb<\/li>\n  <li><strong>Give a role and a choice.<\/strong> \u00ab&nbsp;Do you want to hold the bandage? Shall we count to three together?&nbsp;\u00bb Control reassures.<\/li>\n  <li><strong>Allow a comfort item, the presence of a familiar adult<\/strong>, a break. The time given is rarely time wasted.<\/li>\n  <li><strong>Never establish a power dynamic or blackmail.<\/strong> If the care is not urgent, postpone, reassure, and communicate to prepare for next time with the team.<\/li>\n<\/ol>\n\n<p><strong>\u274c To avoid&nbsp;:<\/strong> \u00ab&nbsp;If you don't stay still\u2026&nbsp;\u00bb, holding forcefully or saying \u00ab&nbsp;it doesn\u2019t hurt&nbsp;\u00bb when it will be unpleasant. A visible lie breaks trust for all future care.<\/p>\n\n<!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 10 \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n<h2 id=\"dyn-s10\">10. \u00ab&nbsp;Don't force her&nbsp;\u00bb \u2014 the family opposes<\/h2>\n\n<p><em>The daughter arrives during the care&nbsp;: \u00ab&nbsp;Don't force her, she doesn't like it, let her be.&nbsp;\u00bb The next day, another relative criticizes the opposite&nbsp;: \u00ab&nbsp;you\u2019re not stimulating her enough.&nbsp;\u00bb You are caught between the instructions and the families' perspectives.<\/em><\/p>\n\n<p>What\u2019s at play: behind a family's intervention, there is almost always worry, guilt, sometimes an unresolved disagreement among relatives. The question of refusal also touches on the trusted person and, where applicable, advance directives&nbsp;: the legal framework of consent applies. Responding substantively in a corridor, justifying yourself, or pitting relatives against each other never works.<\/p>\n\n<ol class=\"dyn-steps\">\n  <li><strong>Welcome the emotion before the argument.<\/strong> \u00ab&nbsp;I understand that it\u2019s difficult to see her refuse. We are looking together for what suits her.&nbsp;\u00bb<\/li>\n  <li><strong>Remind the principle, without opposing.<\/strong> \u00ab&nbsp;We do not force; we propose differently, we respect her refusal, and we communicate with the team.&nbsp;\u00bb<\/li>\n  <li><strong>Offer the right framework<\/strong>&nbsp;: a time for discussion with the supervisor or doctor rather than an improvised decision between two doors.<\/li>\n  <li><strong>Document the exchange.<\/strong> A family's concern that is not communicated resurfaces later, amplified. The written note protects the person, the family, and the team.<\/li>\n<\/ol>\n\n<p><strong>\u274c To avoid&nbsp;:<\/strong> \u00ab&nbsp;We decide&nbsp;\u00bb or, conversely, changing a medical instruction alone because a relative requested it. Refusal is decided with the person, within the framework set by the team and the doctor.<\/p>\n\n<!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 R\u00c9CAPITULATIF \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n<h2 id=\"dyn-recap\">Refusal of care, what to do&nbsp;: the summary table<\/h2>\n\n<p>Ten scenes, one common thread&nbsp;: seek the message behind the \u00ab&nbsp;no&nbsp;\u00bb, adjust the \u00ab&nbsp;how&nbsp;\u00bb, never force, communicate a fact. Before the table, four reflexes applicable in almost all situations.<\/p>\n<div class=\"dyn-cards\">\n  <div class=\"dyn-card\">\n    <span class=\"dyn-card__icon\">\ud83d\udd0e<\/span>\n    <h3>Search for the cause<\/h3>\n    <p>A new refusal first makes one think of pain, discomfort, treatment. We observe and report before interpreting.<\/p>\n  <\/div>\n  <div class=\"dyn-card\">\n    <span class=\"dyn-card__icon\">\ud83e\udd1d<\/span>\n    <h3>Negotiate how<\/h3>\n    <p>We keep the goal, we let go of the accessory: the time, the order, the portion, the person providing the care. Choice gives control.<\/p>\n  <\/div>\n  <div class=\"dyn-card\">\n    <span class=\"dyn-card__icon\">\ud83d\uded1<\/span>\n    <h3>Do not force<\/h3>\n    <p>Postpone, pass the baton, come back. A forced care costs more than a postponed care: it closes the door to the next ones.<\/p>\n  <\/div>\n  <div class=\"dyn-card\">\n    <span class=\"dyn-card__icon\">\u270d\ufe0f<\/span>\n    <h3>Transmit accurately<\/h3>\n    <p>A fact that is dated and located, never a label. \u201cRefuses at 4 PM, accepts at 9 AM\u201d is useful; \u201copponent\u201d is not.<\/p>\n  <\/div>\n<\/div>\n\n<div class=\"dyn-tablewrap\">\n<table>\n  <thead>\n    <tr><th>Situation<\/th><th>What it often concerns<\/th><th>\u2705 The reflex to have<\/th><th>\u274c To avoid<\/th><\/tr>\n  <\/thead>\n  <tbody>\n    <tr><td>Morning toilet refused<\/td><td>Intimacy, difficult waking, surprise<\/td><td>Announce, offer a choice, negotiate the portion<\/td><td>Discover and insist<\/td><\/tr>\n    <tr><td>Pill spat out<\/td><td>Pain, taste, swallowing, mistrust<\/td><td>Look for the obstacle, report<\/td><td>Crush in secret<\/td><\/tr>\n    <tr><td>Meal left aside<\/td><td>Pain, nausea, morale, habits<\/td><td>Accompany, seek the cause, trace<\/td><td>Force to eat<\/td><\/tr>\n    <tr><td>Refusal to get up<\/td><td>Pain in movement, morale, fatigue<\/td><td>Look for the pain, aim for a small step<\/td><td>Force to lift<\/td><\/tr>\n    <tr><td>Change \/ intimate care blocked<\/td><td>Modesty, fear, too quick gestures<\/td><td>Announce each gesture, preserve intimacy<\/td><td>Maintain to go fast<\/td><\/tr>\n    <tr><td>Refusal that escalates to screams<\/td><td>Overflow, overstimulation, pain<\/td><td>Stop the care, lower the voice, calm<\/td><td>Raise the tone, coerce<\/td><\/tr>\n    <tr><td>\u201cNot you\u201d<\/td><td>Felt gesture, preference, reference points<\/td><td>Welcome, seek the detail, relay<\/td><td>Justify, insist<\/td><\/tr>\n    <tr><td>Refusal without words<\/td><td>Autism, aphasia, advanced disorders<\/td><td>Show, slow down, visual supports<\/td><td>Conclude \u201che understands nothing\u201d<\/td><\/tr>\n    <tr><td>Young person who refuses<\/td><td>Fear of the unknown, of pain<\/td><td>Get to their level, reassure, give a role<\/td><td>Blackmail, force, lie<\/td><\/tr>\n    <tr><td>\u201cDo not force her\u201d<\/td><td>Worry, family guilt<\/td><td>Welcome, remind the framework, trace<\/td><td>Oppose, decide alone<\/td><\/tr>\n  <\/tbody>\n<\/table>\n<\/div>\n\n<div class=\"dyn-note\">\n  <strong>\u2139\ufe0f Refusal is a right<\/strong>\n  <p>In France, free and informed consent to care \u2014 and therefore the possibility to refuse it \u2014 is enshrined in the Public Health Code. A refusal is sought, explained, traced, and respected: it cannot be circumvented. These guidelines do not replace the protocols of your establishment or the opinion of the healthcare professional for any individual situation.<\/p>\n<\/div>\n\n<!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 SERIES \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n<h2>To go further<\/h2>\n\n<p>These ten scenes show the \u201cwhat to do\u201d in the moment. To sustainably anchor a response to <strong>refusal of care<\/strong> \u2014 what to do not only on the same day but over time and as a team \u2014 three deepening articles from the same series extend this article.<\/p>\n<div class=\"dyn-serie\">\n  <a href=\"#comprendre\"><span>Background Guide<\/span>Refusal of care: the complete guide to understanding what is at stake<\/a>\n  <a href=\"#activites\"><span>Toolbox<\/span>Activities, resources, and concrete arrangements to implement<\/a>\n  <a href=\"#posture\"><span>Professional posture<\/span>Posture, teamwork, and skill development in the face of refusal<\/a>\n  <a href=\"#formation\"><span>The training<\/span>Program, content, and who the \"Refusal of care\" training is for<\/a>\n<\/div>\n\n<p>On the side of free resources, several DYNSEO tools directly serve these situations: the <a href=\"https:\/\/www.dynseo.com\/nos-outils\/roue-des-choix\/\">choice wheel<\/a> to empower the person, the <a href=\"https:\/\/www.dynseo.com\/nos-outils\/thermometre-des-emotions\/\">emotion thermometer<\/a> to detect the rise before the crisis, and the entire <a href=\"https:\/\/www.dynseo.com\/nos-outils\/\">tool catalog<\/a>. To maintain the connection and stimulation on a daily basis, the application <a href=\"https:\/\/www.dynseo.com\/en\/brain-games-apps\/scarlett-brain-games-for-seniors\/\">SCARLETT<\/a> supports elderly people, including in the context of Alzheimer's disease or Parkinson's, while <a href=\"https:\/\/www.dynseo.com\/en\/brain-games-apps\/clint-brain-games-for-adults\/\">CLINT<\/a> is aimed at adults in mental health or after a Stroke. Finally, the <a href=\"https:\/\/www.dynseo.com\/nos-tests\/\">cognitive tests<\/a> help better assess a person's abilities before adapting care.<\/p>\n\n<!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 FAQ \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n<h2 id=\"dyn-faq\">Frequently Asked Questions<\/h2>\n<div class=\"dyn-faq\">\n\n  <h3>Are we allowed to refuse care&nbsp;?<\/h3>\n  <p>Yes. In France, free and informed consent is a principle enshrined in the Public Health Code&nbsp;: an informed person can refuse care, even when this refusal seems unreasonable to the professional. The team's role is then to inform clearly, to seek the reason for the refusal, to propose alternatives, and to document the decision. For a person whose discernment is impaired, the trusted person, advance directives, and medical advice come into play. Forcing care outside of any framework exposes the person and engages the professional's responsibility&nbsp;: the refusal must be respected, it cannot be circumvented.<\/p>\n\n  <h3>Refusal of care, what to do in case of a vital emergency&nbsp;?<\/h3>\n  <p>The situation changes in nature. In the face of a vital distress \u2014 loss of consciousness, major respiratory difficulty, hemorrhage, signs suggesting a Stroke \u2014 we ensure the person's safety, apply the emergency procedure of the establishment, and contact the emergency services of your country. The emergency takes precedence over the analysis of the refusal. Outside of vital emergencies, however, a refusal needs to be addressed&nbsp;: we do not turn every opposition into an emergency situation to justify overriding it. In case of doubt about the urgent nature, we promptly consult the nurse, supervisor, or doctor.<\/p>\n\n  <h3>How to avoid forcing without \"giving up\" on care&nbsp;?<\/h3>\n  <p>Not forcing is not giving up. It is shifting the effort from \"if\" to \"how\"&nbsp;: postponing to a better moment, breaking the care into small steps, offering a choice, changing the caregiver, adapting the environment. A postponed and accepted care is better than a forced care that will lead to refusal the next day. When the refusal persists despite these adjustments, we do not persist alone&nbsp;: we precisely communicate what has been attempted and bring the question to the team. It is this combination \u2014 flexibility in form, insistence on the objective, collective decision-making \u2014 that protects both the person and the quality of care.<\/p>\n\n  <h3>What to note in communications after a refusal&nbsp;?<\/h3>\n  <p>A dated, located, and reproducible fact, not an interpretation. \u201c&nbsp;Refusal of bathing at 7:40 AM, accepted at 9 AM after coffee&nbsp;\u201d is actionable&nbsp;: it guides and allows for team decision-making. \u201c&nbsp;Opposing&nbsp;\u201d or \u201c&nbsp;fickle&nbsp;\u201d adds nothing and misleads colleagues for months. Also note what worked&nbsp;: the time, the wording, the caregiver, the arrangement. This positive information is as valuable as the refusal itself, as it makes the next care possible. A useful communication describes an observable behavior, never a personality label.<\/p>\n\n  <h3>How to protect the team against repeated refusals&nbsp;?<\/h3>\n  <p>A recurring refusal is exhausting&nbsp;: feelings of failure, tension, sometimes guilt. The first lever is to break out of isolation&nbsp;: discuss it in meetings, collectively decide on the level of assistance and instructions, write down what works so that everyone applies the same approach, including substitutes. The second is to remember that a respected refusal is not a professional fault&nbsp;: it is often a sign of quality support. Training finally provides a common vocabulary and shared benchmarks, which calms the team as well as the relationship with the supported person.<\/p>\n\n<\/div>\n<div class=\"dyn-note\">\n  <strong>\u2139\ufe0f Information and not medical advice<\/strong>\n  <p>This article provides general professional guidelines. It does not replace the protocols of your establishment, individual prescriptions, or the opinion of the care team. For any diagnosis, prognosis, or therapeutic decision, refer to the healthcare professional and your supervision. In case of emergency, contact the emergency services of your country.<\/p>\n<\/div>\n\n<!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 CTA FINAL \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n<div class=\"dyn-cta\">\n  <h3>In the face of refusal of care, know what to do \u2014 and why<\/h3>\n  <p>From morning hygiene to silent refusals, knowing <strong>what to do in the face of a refusal of care<\/strong> is learned: understanding what is at stake, negotiating without forcing, respecting consent, communicating clearly. The training <strong>\u201cRefusal of care: understanding, negotiating, and respecting \u2014 a gentle and ethical approach\u201d<\/strong> brings all this together in 16 lessons, 100% online, unlimited access, with a certificate of completion. Certified organization Qualiopi No. 11757351875.<\/p>\n  <a class=\"dyn-btn\" href=\"https:\/\/www.dynseo.com\/courses\/refus-de-soins-comprendre-negocier-et-respecter-une-approche-douce-et-ethique\/\">Discover the training \u2014 90 \u20ac<\/a>\n<\/div>[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section]","_et_gb_content_width":"","footnotes":""},"categories":[3582],"tags":[],"class_list":["post-759516","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-advice-from-our-coaches"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.1 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Refusal of Care: 10 Difficult Everyday Situations and How to Respond - DYNSEO - Educational apps &amp; brain training apps for all<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.dynseo.com\/en\/refusal-of-care-10-difficult-everyday-situations-and-how-to-respond\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Refusal of Care: 10 Difficult Everyday Situations and How to Respond - DYNSEO - Educational apps &amp; 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