Understanding the Right to Refuse Medical Care
In the United States, every competent adult has the right to refuse unwanted medical care and treatment. The right arises from the concept that an individual has the ability to choose what will or will not be done in regard to his or her body. The right to refuse treatment extends to situation in which declining treatment will result in the death of the person asserting that privilege.
There are a number of facts and factors associated with the refusal of medical care which are worth exploring. We are all better served having a clearer understanding of the right to refuse medical care.
There are four important areas associated with the right to refuse medical care which specifically are discussed in this informational article:
- Concept of autonomy and refusal of medical care
- Informed consent
- Older people and refusal of medical care
- Medical directive and refusal of care and treatment
- Durable power of attorney for healthcare
Concept of Autonomy and Refusal of Medical Care
According to the National Library of Medicine (of the National Institutes of Health), a person’s right to refuse medical care and treatment is founded upon the ethical principle of autonomy. According to the National Library of Medicine, the principle of autonomy states that every individual has the right to make informed decisions about their healthcare. Healthcare professionals should not impose their own beliefs or decisions upon their patients. Autonomy does not exist alone. There are other medical principles that help guide care.
The medical principles that guide patient autonomy and declining medical care are:
- Beneficence: Beneficence requires that actions taken by healthcare professionals be for the benefit of the patient.
- Non-maleficence: Non-maleficence is the principle that embodies the well-known medical admonition of “do no harm.” Do no harm requires healthcare providers to take steps to ensure their patients and society at large are not harmed by their actions.
- Justice: Justice necessitates that the benefits and risks associated with healthcare should be distributed equally amongst the population without bias.
In the realm of medical ethics, each principle has a role when navigating the difficult situations where patients or their family members may be refusing medical assistance.
We borrow (with permission) the materials used by the National Cancer Society to explain what is known as informed consent. Although the National Cancer Society is dedicated to finding a cure for cancer, the explanation of informed consent provided by this organization is applicable across the board when it comes to medical informed consent:
Informed consent is a process of communication between you and your health care provider that often leads to agreement or permission for care, treatment, or services. Every patient has the right to get information and ask questions before procedures and treatments. If adult patients are mentally able to make their own decisions, medical care cannot begin unless they give informed consent.
The informed consent process makes sure that your health care provider has given you information about your condition along with testing and treatment options before you decide what to do.
The four primary elements of informed consent are:
- Name of medical condition
- Name of the procedure or treatment that the health care provider recommends
- Risks and benefits of the treatment or procedure
- Risks and benefits of other options, including not getting the treatment or procedure
Older People and Refusal of Medical Care
The refusal of medical care is more commonplace among older individuals, according to the Journal of Palliative Medicine. According to the Journal, one of the key principles of good patient care is the respect of and receptivity to patients’ wishes and values. It is important to understand patients’ perspectives about medical care and treatment.
A competent older individual has the right to refuse medical treatment after being provided appropriate information about the care being declined. There are a number of factors associated with refusal of medical care by a senior that warrant special consideration:
- In order to refuse medical care, the senior citizen must be competent. What this means is that an older individual understands the nature and extent of the medical condition as well as understands that nature and resulting prognosis of a proposed course of treatment. The older person also needs to understand the prognosis for not undergoing treatment.
- In order to refuse medical treatment, an older person must decline care as a free and voluntary act. No one can be pressured, coerced, or duped into declining medical care and treatment.
Medical Directive and Refusal of Care and Treatment
There are situations in which an emergency situation arises and an older person is not able to make decisions about medical care and treatment directly. This underscores the reason why every adult needs a medical directive.
A medical directive sets forth those courses of care and treatment that are not acceptable to a particular individual. Generally speaking, healthcare providers are expected to honor what is set forth in a medical directive, including what courses of care and treatment are not acceptable to a particular person.
Durable Power of Attorney for Healthcare
Another important legal instrument is what is known as a durable power of attorney for healthcare. This instrument designates another adult who makes decisions regarding medical care and treatment, in accordance with what is set forth in a medical directive. This would be the individual who refuses certain types of medical care on your behalf if you ever become incapable of doing so directly or on your own.