What part of "no" don't you understand? Patient refusal of recommended treatment in the emergency department

Abstract

Patient refusal of indicated medical treatment, especially when the treatment would be life sustaining, presents all physicians, especially emergency physicians, with the responsibility of determining whether the patient has the capacity to refuse treatment, and whether the patient's refusal is informed. These two crucial questions present a number of dilemmas for physicians who may have no prior relationship with that particular patient. The ethical and legal principles for determining decision-making capacity and assuring that refusal is informed are described, and an algorithm for responding to patient refusals is presented.