Refusal of medical treatment
Legally Speaking
Clifford Warren Lober, MD, JD, presents legal dilemmas in dermatology every other month. He is a dermatologist in practice in Florida and a partner in the law firm Lober, Brown, and Lober.
By Clifford Warren Lober, MD, October 1, 2019
Question: When can a patient refuse medical treatment?
Answer: A patient who is legally competent usually has the right to consent to, or refuse, any and all medical treatment. Competency is defined by state statutes which dictate who can make legally valid, binding decisions. To be legally competent, the patient typically must be at least 18 years old and have the ability to understand and assess the risks and benefits of treatment alternatives. Persons with impaired mental capacity, such as those with significant psychiatric illness or inebriation, are legally incompetent. If there is a question concerning mental capacity, the courts usually consider the advice of medical experts when making the final determination.
Q: Can a person who is legally competent refuse treatment even if it may result in their death?
A: If a person is legally competent and has the capacity to make informed decisions, they can refuse any and all medical treatment even if it results in their death. The fact that their decision may be against medical advice does not strip the patient of the right to refuse.
Q: Why do patients refuse medical treatment?
A: The most common reasons include a genuine belief the treatment is not necessary, fear of complications such as pain or disfigurement, and financial expense. Some may also object to medical interventions for religious reasons.
Q: Do federal laws protect this right?
A: The Patient Self-Determination Act of 1990 requires that hospitals, skilled nursing facilities, hospice programs, home health agencies, and health maintenance organizations inform patients of their right to participate in medical decisions and execute advance directives. Before passage of this Act, many patients felt pressured to accept costly or invasive treatments they truly did not desire. Many states also have laws that reinforce a legally competent patient’s right to refuse treatment.
Q: When does a patient not have the right to refuse medical treatment?
A: Individuals who are not legally competent, such as children, usually do not have the right to refuse medical treatment if their parent or guardian approves of the intervention. Furthermore, a patient who is a genuine threat to the community may not have the right to refuse treatment. Individuals who have communicable diseases, for example, may not (under certain circumstances) have the right to refuse isolation or other interventions.
Q: What should I do if a patient refuses treatment?
A: You should be certain that the patient clearly understands the benefits and risks of all relevant treatment alternatives, specifically including the risk of doing nothing (informed refusal). The patient should be given the opportunity to ask questions and discuss the situation. If they still refuse treatment, document that they were given all relevant information needed to make an informed decision.
Q: Other than not receiving the recommended treatment, what are the consequences of a patient refusing treatment?
A: If the patient is in a hospital, their insurance may have the right to decline coverage if the patient leaves against medical advice. Furthermore, if they are receiving disability benefits and refuse treatment that might cure or minimize their disability, they may find their disability benefits terminated or reduced. This should be pointed out to patients considering refusing recommended medical treatment.
