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Physicians generally recommend that patients resuscitated with naloxone after opioid overdose stay in the emergency department for a period of observation in order to prevent harm from delayed sequelae of opioid toxicity. Patients frequently refuse this period of observation despiteenefit to risk. Healthcare providers are thus confronted with the challenge of how best to protect the patient's interests while also respecting autonomy, including assessing whether the patient is making an autonomous choice to refuse care. Previous studies have shown that physicians have widely divergent approaches to navigating these conflicts. This paper reviews what is known about the effects of opioid use disorder on decision-making, and argues that some subset of these refusals are non-autonomous choices, even when patients appear to have decision making capacity. This conclusion has several implications for how physicians assess and respond to patients refusing medical recommendations after naloxone resuscitation. [ABSTRACT FROM AUTHOR]

In the health professions, altruism is a foundational value upon which professional privilege is built. This imperative towards self-sacrifice for the benefit of others is a key component of what it means to be professional. This paper explores how altruism operates as a coded mechanism of exclusion and oppression for disabled health professionals. Analysis is based on interviews with fifteen Canadian disabled healthcare professionals in medicine, nursing, occupational therapy, and social work about their experiences of inclusion and exclusion. Themes including the disproportionate sacrifice of time, resources, and income emerged, as did the need to manage political disclosure, often embodying the role of the 'super-crip' with patients/clients and colleagues so as to maintain others' faith in their professional competence and their professional privilege. Further discussion includes questions of how to 'crip' altruism as a professional value and the role of altruism as an ableist force within the health professions. Altruism, the idea of helping others even at cost to oneself, is an important value for health professionals. Disabled health professionals sacrifice more than non-disabled healthcare professionals to meet this obligation. Disabled healthcare professionals may work without accommodations, putting in extra time and effort to prove their altruism. Disabled healthcare professionals experience that disclosing disability may mean their colleagues will treat them as patients. [ABSTRACT FROM AUTHOR]