The right to refuse medical treatment.

Abstract

It is becoming an increasingly frequent occurrence for the emergency nurse to encounter patients and families who question treatment offered in the emergency department and who even refuse treatment. In general, a competent, conscious adult has the right to refuse medical treatment. The key to handling the patient who refuses treatment in the emergency department is careful assessment of the patient and the apparent reason for his refusal of treatment. The emergency nurse who is confronted with a patient who refuses care must initially ask whether the patient is mentally competent to refuse treatment. Is the patient’s ability to reason impaired by drugs or alcohol? Does the patient show signs of organic mental impairment? Patients who are disoriented, confused, or unable to comprehend this condition should not be permitted to leave the emergency department. It is appropriate to use reasonable restraints when necessary to maintain the patient in the emergency department, pending further medical evaluation of his condition. Documentation of the patient’s physical and mental status should be carefully noted on the ED record, as well as careful notation of the need for any reasonable restraints. If the patient who insists on leaving without treatment appears to be in control of his mental processes, the ED staff has a duty to warn the patient