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I'm not in healthcare either and I totally see your point.
But, i guess, the situation is complicated. What do you do with a 7 year old child who doesn't want to go to school? Send them anyways, probably, tell them they have to because it's good for them. Now, why do parents behave that way? Because they assume the child doesn't understand the full implications of their choices.
With patients it's a bit similar. Sure you can tell them they're going to die if they refuse medication, but will they really understand the depthness of that? Probably they can't even imagine it, idk. Could you imagine your own death? I guess for a lot of people that's just a difficult thing to imagine, possibly also because monkey brain conveniently completely has a blind spot for that option (remember people driving recklessly, for an example).
So, you have to estimate: Does the person really fully understand what's happening, or are they just brushing it off as an "yes the doctor wants to scare me to give more expensive treatment, extracting money out of me" thingy. You can't assume all patients have studied medicine and understand the deep connections. Does the person really know what they're talking about, or are they only looking at things at a superficial level?