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<article xlink="http://www.w3.org/1999/xlink" dtd-version="1.0" article-type="family-medicine" lang="en">
<front>
<journal-meta>
<journal-id journal-id-type="publisher">JOHS</journal-id>
<journal-id journal-id-type="nlm-ta">Journ of Health Scien</journal-id>
<journal-title-group>
<journal-title>Journal of HealthCare Sciences</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Journ of Health Scien</abbrev-journal-title>
</journal-title-group>
<issn pub-type="ppub">2231-2196</issn>
<issn pub-type="opub">0975-5241</issn>
<publisher>
<publisher-name>Radiance Research Academy</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="publisher-id">492</article-id>
<article-id pub-id-type="doi">http://dx.doi.org/10.52533/JOHS.2025.51227</article-id>
<article-id pub-id-type="doi-url"/>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Family Medicine</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Clinical and Ethical Considerations in Assessing Decision-Making Capacity Among Uncontrolled Type 2 Diabetic Patients Refusing Insulin Therapy
</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Aljafen</surname>
<given-names>Ahmed Saleh</given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Alamri</surname>
<given-names>Saeed Abdulrahim</given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Aljhni</surname>
<given-names>Amair Obidallah</given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Alsubhi</surname>
<given-names>Maram Musa</given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Alnughaymishi</surname>
<given-names>Abdullah Saleh</given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Binnwejim</surname>
<given-names>Mohammed Saleh</given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Althagafi</surname>
<given-names>Khalid Abdullah</given-names>
</name>
</contrib>
</contrib-group>
<pub-date pub-type="ppub">
<day>31</day>
<month>12</month>
<year>2025</year>
</pub-date>
<volume>5</volume>
<issue>12</issue>
<fpage>928</fpage>
<lpage>933</lpage>
<permissions>
<copyright-statement>This article is copyright of Popeye Publishing, 2009</copyright-statement>
<copyright-year>2009</copyright-year>
<license license-type="open-access" href="http://creativecommons.org/licenses/by/4.0/">
<license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution (CC BY 4.0) Licence. You may share and adapt the material, but must give appropriate credit to the source, provide a link to the licence, and indicate if changes were made.</license-p>
</license>
</permissions>
<abstract>
<p>Uncontrolled type 2 diabetes remains a major global health concern, with insulin therapy often required when oral medications fail to maintain glycemic targets. However, many patients resist insulin initiation despite clinical indications, presenting challenges that intersect medical judgment, ethics, and patient rights. Refusal of insulin is frequently influenced by complex factors, including fear of injections, cultural beliefs, stigma, and misconceptions about disease progression. Emotional states such as depression and anxiety, common in patients with poorly managed diabetes, further shape refusal behavior and may impair the ability to make fully informed choices. At the same time, chronic hyperglycemia and diabetes-related complications can affect cognitive functions such as memory, attention, and executive capacity, raising concerns about decision-making competence. Clinicians are often placed in ethically difficult positions, balancing respect for patient autonomy with professional obligations to protect health and prevent avoidable harm. Assessing decision-making capacity in this context is not always straightforward, especially in the absence of clear guidelines or institutional support. Ethical conflicts arise when a patient__ampersandsign#39;s consistent refusal of therapy appears influenced by cognitive decline or psychological distress. Informal assessments of capacity, inconsistent documentation, and time-limited care environments may further complicate ethical decision-making. Family dynamics, cultural context, and clinician biases also play a role in how decisions are interpreted and acted upon. Efforts to navigate these dilemmas require a nuanced approach that integrates cognitive assessment, emotional evaluation, and ethical reflection. Structured capacity evaluations, interdisciplinary collaboration, and culturally sensitive communication can support ethical integrity while ensuring patients receive appropriate care. Understanding the motivations and limitations behind insulin refusal is essential for developing ethically sound and clinically effective responses in the management of complex diabetes cases.
</p>
</abstract>
<kwd-group>
<kwd>decision-making capacity</kwd>
<kwd> insulin refusal</kwd>
<kwd> type 2 diabetes</kwd>
<kwd> medical ethics</kwd>
<kwd> cognitive impairment</kwd>
</kwd-group>
</article-meta>
</front>
</article>