One of the most challenging words we must learn to use is “no.” It is contrary to our being, our desire to be happy, and our desire to be liked by others; “no” is negative, whereas most of us prefer positivity. In the medical industry, knowing when to decline can also prevent adverse consequences. Not everyone wants to improve, nor does everyone want our treatment regimen to succeed; it is imperative to ask the right questions and ensure that our patients want our treatment to work.
Physicians offering regenerative therapies have strong ethical and regulatory reasons to decline many patient requests, especially when evidence is weak, indications are inappropriate, or expectations are distorted. The indication being addressed is not essential; however, physicians in aesthetic and elective medicine may not only decline inappropriate requests but also have an ethical obligation to do so when a procedure is unlikely to benefit the patient, carries disproportionate risk, or is driven by distorted motivations or expectations.
Why declining can be the proper treatment
Regenerative medicine sits at the intersection of genuine promise and widespread hype, which magnifies the duty to protect patients from unproven or unsafe interventions, fostering a sense of responsibility and trustworthiness in your role.
When the likely benefit is low, the risk is uncertain, or the request is driven by desperation and marketing rather than data, saying no can strengthen your confidence and uphold your professional integrity without implying abandonment.
- Some stem cell and regenerative offerings marketed directly to consumers lack robust clinical evidence, standardized protocols, or long-term safety data.
- The unproven stem cell intervention industry is now recognized as a global public health issue, with concerns about physical harm, financial exploitation, and erosion of trust in legitimate research.
In elective medicine, the default is not “the customer is always right” but “first, do no harm.” When a requested procedure is unlikely to improve the patient’s health, functioning, or well-being—or may even worsen it—declining is often the most ethical option.
- Aesthetic and cosmetic procedures should only be offered when the clinician reasonably believes they can achieve what the patient desires in a safe, proportionate way.
- Saying no protects patients from physical complications, psychological harm, and financial loss, and protects the clinician from avoidable complaints, litigation, and reputational damage.
Red flags specific to regenerative requests
Specific clinical and contextual features should prompt a pause and often a firm “no” to elective regenerative treatments, such as requests for unproven cell therapies or patients bypassing standard care protocols.
- Non-evidence-based indications: Requests for cell or biologic injections in conditions where high-quality data are absent or clearly negative (for example, broad “anti-aging,” neurodegenerative diseases in unregulated settings) should be declined outside of approved trials.
- Bypassing standard care: Patients seeking regenerative options before exhausting guideline-directed conservative therapies (rehab, medications, surgery where appropriate) are often responding to marketing rather than medical necessity.
- Vulnerable or desperate patients: Those with progressive, life-threatening, or disabling conditions who have “tried everything” are at high risk of being harmed by unrealistic claims and high out-of-pocket costs.
- Unrealistic expectations about outcomes: Belief that a single injection will “regrow cartilage,” “reverse aging,” or cure complex systemic disease is incompatible with current evidence and should trigger a re-education conversation, not a consent form.
- Body image pathology: Red flags include disproportionate distress about minor or invisible flaws, multiple prior “unsuccessful” procedures, or signs of body dysmorphic disorder; in such cases, surgery is not morally justified and psychological evaluation is recommended instead.
- Inability to tolerate normal risk: Patients who cannot accept the possibility of scars, asymmetry, need for revision, or imperfect results are at high risk of dissatisfaction and complaint even after technically good work.
- Problematic history or behavior: Prior lawsuits against physicians, non-adherence to medical advice, hostile or manipulative communication, or pressure to bypass safety protocols should all weigh heavily toward declining.
A practical framework for patient selection
To decide when to consider regenerative treatment versus when to decline, clinicians can use a simple, structured framework.
- Evidence and indication: Offer regenerative interventions only where there is at least credible clinical evidence, clear rationale, and conformity with professional or institutional guidelines; otherwise, restrict access to ethically approved trials or registries.
- Risk–benefit and alternatives: Confirm that the intervention’s potential benefit reasonably outweighs its risks and financial burden compared with established options, and that the patient has had an honest discussion of standard therapies first.
- Regulatory and practice setting: Ensure the product, processing, and delivery comply with applicable regulations and oversight (for example, avoiding unapproved “stem cell source” and offshore offerings marketed as cures).
- Patient capacity and motivation: Assess understanding, psychological state, and motivation; if the decision is driven primarily by fear, high-pressure advertising, or family coercion, the ethical response is often to decline and redirect.
Declining a regenerative request requires clear, respectful communication that emphasizes advocacy for the patient’s interests. Framing this well can help you feel capable and confident during challenging discussions.
Declining a regenerative request requires clear, respectful communication that emphasizes advocacy for the patient’s interests.
- Lead with transparency: Explain that regenerative medicine is a rapidly evolving field with pockets of promise and many areas where therapies remain experimental or unproven.
- Reframe the role: Position yourself as a filter against misleading advertising and unregulated clinics, and explicitly contrast your approach with direct-to-consumer businesses that overstate efficacy and minimize risk.
- Offer a constructive path: When declining, provide alternatives such as referral to evidence-based clinical trials, guideline-consistent treatments, or a specialist second opinion, and discuss realistic expectations for symptom management rather than cure.
- Documenting the decision to decline, including the clinical assessment, evidence discussion, and rationale, is essential to uphold ethical standards and protect both patient and clinician if care is later pursued elsewhere.
Building clinic policies around “no.”
Formal policies help individual clinicians feel supported when they appropriately refuse regenerative treatments. Emphasizing this support can reinforce their confidence and sense of ethical integrity.
- Written criteria: Develop clinic-wide eligibility criteria for each regenerative service (indications, contraindications, required prior therapies, and exclusion for high-risk or unrealistic cases), aligned with major guidelines and regulatory expectations.
- Staff training: Train all team members to recognize high-risk inquiries (for example, “stem cell cures for everything,” overseas treatment demands) and to route these patients into an education-first consult rather than a quick booking.
- Patient education materials: Provide handouts or web pages summarizing the limits of current evidence, the problems with unregulated stem cell markets, and how the practice decides when a regenerative option is appropriate vs when it is not.
How to say no without hurting the relationship
Saying no does not have to be adversarial; handled well, it can deepen trust and sometimes even prompt referrals.
- Lead with beneficence: Frame the decision explicitly around the patient’s best interests— “My concern is that this procedure is unlikely to give you the outcome you are hoping for, and could expose you to unnecessary risk.”
- Be transparent about reasoning: Briefly explain the specific clinical, psychological, or risk-benefit factors that make the patient a poor candidate, using plain language and avoiding judgmental terms.
- Offer alternatives: When appropriate, suggest non-procedural options (counseling, skin care, weight management, watchful waiting) or a second opinion, and consider referral to mental health professionals if body image pathology is suspected.
- Document thoroughly: Record the discussion, your assessment of expectations and mental state, your explanation of risks and likely outcomes, and the fact that you declined based on professional judgment; this also reduces medicolegal exposure.
Declining more often will yield more positive long-term outcomes for you and your patients. Learn to read the signs and understand who wants to improve, whether they wish to return to work, whether litigation is involved, and whether psychological issues are present. Ask the right questions, and establish a relationship that ensures you are both working towards the goal of recovery. You will all end up happier.