💥Refuse vs Decline💥

I just saw a nice little video about this and it reminded me to elaborate on the difference between the two!

In healthcare, the use of the word ‘refuse’ instead of ‘decline’ really boils my pi**.

While the two have roughly the same broad meaning (saying no to an offer/invitation/even recommendation), the associations in our heads regarding the two words can be very different, and that hugely influences how we perceive the person who is refusing/declining something, with a potential impact how we think and feel about them, and how we may offer care to them and treat them in the future. Even if it’s not intentional, and more subconscious.

Refuse has associations of unreasonableness, childishness, pigheadedness, being obstinate, and possibly rude.

Decline is polite, formal, quite reasonable and has absolutely no undertones of rudeness or unreasonableness.

Basically, ‘refuse’ in many peoples heads is similar to:

Absolutely f***ing not, are you kidding? NO!!!’ maybe with a sullen expression, and potentially in a raised voice (btw, having to do this as a pregnant person is also absolutely fine....if we are not respecting autonomy and choice, we have to be prepared to be put in our place!).

Whereas ‘decline’ is a simple and considered: ‘No, thank you.’ possible delivered with a smile.

I know this is hyperbole 😬, but really, the two are very different in a healthcare context. So it would be wonderful if we could consider this when documenting or talking to colleagues. While the ‘refuse’ terminology might not have hugely negative connotations for YOU, it does for many people, some of whom may be reading your documentation, or receive your handover.

And a person who is considered rude, stubborn and unreasonable DOES receive different care and communication from a person considered to be polite and reasonable. (Wherever that may mean.).

There is also the power imbalance that gets highlighted here. As already mentioned, refusing to do/accept something assumes that it really OUGHT to be accepted, which assumes a: the HCP is right, and b: they have the power to decide what should happen. The balance of power is tipped towards the HCP 🧐.

Being able to decline puts the power firmly into the decliners hands. As it should be 😬.

So yeah, there IS a difference, even though the basic meaning is very similar. It’s worth remembering that 🖤 (illustration my me 🤓)