Medicine harms constantly — surgery, chemotherapy, every intravenous line ever placed — so “do no harm” cannot mean what it says. Two tools here. Build a clinical act and run it through the four gates of double effect; then move a marker across the field where beneficence collides with autonomy and watch soft paternalism turn into hard.
Load a case, or build one
Place the case
How autonomous is this refusal?
Intentional, understood, voluntary — and made by someone with capacity for this decision.
Delirious, intoxicated, acutely confusedLucid, informed, consistent over time
How grave is the harm of honouring it?
Severity, probability and above all reversibility of what follows if you do nothing.