“Thanks, But No Thanks!” Patient Refusal of ED Diagnosis and Treatment

Abstract

Patient refusal of medical treatment that appears to be in the patient’s best interest is a common challenge for emergency physicians. In the United States, adults have the right to refuse treatment, including life-sustaining medical treatment. The patient must both possess the capacity to make the decision and be offered an opportunity to understand the potential consequences of refusal. The determination of capacity is necessary in deciding when to honor a patient’s refusal. Parents and guardians generally have the right to make health care decisions for their children, but those decisions need to align with the best interests of the child. Documentation of the patient’s refusal of treatment against medical advice may be of some evidentiary value but does not ensure legal protection from liability. Patients who have the capacity to refuse medical treatment should be offered the opportunity to learn and consider the potential consequences before physicians respect their autonomous refusal.