Do Patients Have the Right to Refuse Medical Treatment?

Is It Okay to Say No to Treatment Recommendations?

Do patients have the right to refuse medical treatment? Can they just say no to prescribed treatments or therapies, no matter what their reason for doing so? Every day, patients are faced with a decision on whether or not to put themselves through medical treatment. In some cases, a recommended treatment will only be a question of comfort or speed of healing. In others, it's a question of quality of life versus the quantity of life.

There are four goals of medical treatment—preventive, curative, management, and palliative. When you are asked to decide whether to be treated or to choose from among several treatment options, you are choosing what you consider to be the best outcome from among those choices. Unfortunately, sometimes the choices you have won't yield the outcomes you prefer. Whether a person has the right to refuse care depends on the patient's circumstances and the reasons they may choose to refuse care.

Informed Consent and the Right to Refuse Treatment

Empty beds in hospital room
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The right to refuse treatment goes hand in hand with another patient right—the right to informed consent.  A patient should only consent to medical treatment if they have sufficient information about their diagnosis and all treatment options available in terms he/she can understand. Before a physician can begin any course of treatment, the physician must make the patient aware of what he plans to do. For any course of treatment that is above routine medical procedures, the physician must disclose as much information as possible so the patient may make an informed decision about his/her care.

When a patient has been sufficiently informed about the treatment options offered by a physician, the patient has the right to accept or refuse treatment for two reasons:

  1. A patient has the freedom to decide what a physician or other health care professional will and won't do.
  2. It is unethical to physically force or coerce a patient into a treatment against their will if they are of sound mind and are mentally capable of making an informed decision. 
  3. If patient competency is questionable, the physician can give the information to a legally appointed guardian or a family member designated by the patient to make decisions for them.

However, there are some patients who do not have the legal ability to say no to treatment. Most of these patients cannot refuse medical treatment, even if it is non-life threatening.

  • Altered mental status: A patient may not have the right to refuse treatment if they have an altered mental status due to alcohol and drugs, brain injury, or psychiatric illness.
  • Children: A parent or guardian cannot refuse life-sustaining treatment or deny medical care from a child. This includes those with religious beliefs that discourage certain medical treatments. Parents cannot invoke their right to religious freedom to refuse treatment for a child.
  • Threat to the community: A patient's refusal of medical treatment cannot pose a threat to the community. Communicable diseases, for instance, would require treatment or isolation to prevent the spread to the general public. A mentally ill patient is another example of a patient that cannot refuse treatment if they pose a physical threat to themselves or others.

In instances of an emergency situation, informed consent may be bypassed if immediate treatment is necessary for the patient's life or safety.

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Non-Life-Threatening Treatment Decisions

Most patients in the United States have a right to refuse care if the treatment is being recommended for a non-life-threatening illness. You have probably made this choice without even realizing it. Maybe you didn't fill a prescription, chose not to get a flu shot or decided to stop using crutches after you sprained an ankle.

You may also be tempted to refuse a treatment for more emotional reasons. Perhaps you know it will be painful or you are afraid of the side effects. There is nothing illegal about choosing to forgo treatment for any of those reasons. They are personal choices, even if they aren't always wise choices.

End-of-Life-Care Refusal

Choosing to refuse treatment at the end of life addresses life-extending or life-saving treatment. The right to refuse end-of-life care was guaranteed to Americans in 1991 with the passage of the federal Patient Self-Determination Act (PSDA). The PSDA mandated that nursing homes, home-health agencies, and HMOs were required by federal law to provide patients with information regarding advance directives, including DNRs (do not resuscitate), living wills, and other discussions and documents. It also guaranteed that Americans could choose to refuse life-sustaining treatment at the end of life.

When you choose not to be treated, knowing that the refusal will shorten your life, it is usually because you are choosing what you believe will be a better quality of life, rather than a longer life that may be less pleasant. Some people, knowing they are going to die soon, even choose to end their own life rather than be faced with decisions that will, in reality, be executed by others.

Be aware that if you choose not to receive life-sustaining treatment, it does not mean you are required to forfeit palliative care, which can be administered even for patients who do not want to be kept alive. Palliative care focuses on relieving pain at the end of life but does not help extend life.

Before you decide against receiving treatment at the end of your life, be sure you've followed steps to help you to make that informed decision.

Refusing Treatment for Financial Reasons

You might also consider refusing treatment if you have been diagnosed with a medical problem that requires very expensive treatment. You may prefer not to spend so much money. Patients make this decision when they believe treatment is beyond their means. They decide to forgo treatment instead of draining their bank accounts.

Sometimes we, as Americans who live in a for-profit healthcare system, are forced to choose between our financial health and our physical health. Our health may force us to decide whether or not to undergo a treatment that we know will clean out our savings or put us into a lifetime of debt.

So the question is—are we allowed to choose against treatment if we know it will cost us every penny we have?

The answer is yes: Most Americans can refuse treatment when they know it will have a negative impact on their finances.

Using Religion to Refuse Treatment

Followers of two Christian religions—Jehovah's Witnesses and Christian Scientists plus a few other non-affiliated churches in different parts of the United States—may be willing to undergo some forms of treatment, but restrict or deny other forms based on their religious beliefs. Each offers clear guidelines for making that determination.

Adults may rely on their church affiliation and its tenets to refuse treatment for themselves if they choose. However, they have less legal standing when it comes to making those choices for their children. Several court cases regarding children with different diseases and medical needs have addressed the legality of refusing treatment based on religious reasons with varying outcomes.

Knowing and Using Your Right to Refuse Medical Care

Those are the circumstances under which patients may make a decision not to be treated. If you are trying to make a refusal decision yourself:

  • Call on a professional shared decision-making expert to help you make this difficult decision. The shared decision-making process helps you weigh your values and beliefs against your options to make the choice that is best for you.
  • Be sure you aren't a patient who is not allowed to refuse medical treatment.
  • Take steps to be sure you are making an informed decision.

Advance Directives

The best way for a patient to indicate the right to refuse treatment is to have an advance directive, also known as a living will. Most patients who have had any treatments at a hospital have an advance directive, or Living Will. This document is kept on file and tells the treatment team the wishes of the patient in the event that they are unable to speak for themselves regarding their medical care.

Medical Power of Attorney

Another way for a patient's wishes to be honored is for the patient to have a medical power of attorney. This designates a person to make decisions on behalf of the patient in the event they are mentally incompetent or incapable of making the decision for themselves.

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