Volume 72 Number 4 July 2005	back to contents

Director of Medical and Legal Affairs, and Associate Director, Center for the Study of Bioethics, Clinical Professor of Bioethics and Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI.

Address all correspondence to Arthur R. Derse, M.D., J.D., Center for the Study of Bioethics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226-0509.

Presented at the Issues in Medical Ethics Conference on "Special Challenges of Emergency Medicine" at Mount Sinai School of Medicine, New York, NY.

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.

KEYWORDS

informed consent, informed refusal, life-sustaining medical treatment, decision-making capacity, emergency treatment, emergency privilege.

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