Anaya Nolan
The right to refuse medical treatment is a complex area of the law, based on the common law right of self-determination of one's body, the ethical principle of respect for autonomy, and the doctrine of informed consent. In the US, the right to refuse treatment has been derived from a federal and state constitutional right to privacy, and the Supreme Court has recognised a constitutionally protected right to refuse medical care under the Due Process Clause. While there are some exceptions, such as for patients deemed mentally incompetent, patients with decision-making capacity generally have the right to accept or decline treatment, even if it may result in a poor outcome.
| Characteristics | Values |
|---|---|
| Right to refuse treatment | Derived from the common law right of self-determination of one’s body, the ethical principle of respect for autonomy, and the doctrine of informed consent |
| Guaranteed to Americans by the federal Patient Self-Determination Act (PSDA) | |
| Derived from a federal and state constitutional right to privacy | |
| Derived from the freedom of religion | |
| Derived from the right to be free from unwanted medical interventions | |
| Derived from the right to refuse life-sustaining medical procedures | |
| Does not apply to children, people declared mentally incompetent, and those who are a threat to the community if untreated | |
| Does not apply to patients under the influence of alcohol or drugs | |
| Does not apply to patients with psychiatric illnesses who are a danger to themselves or others, or unable to provide for their basic needs | |
| Does not apply if there is an imminent threat of serious bodily injury or death within 24 hours | |
| Does not apply if there is a court-appointed guardian with the power to consent to treatment | |
| Informed consent | Requires the patient to fully understand the benefits, risks, and alternatives to treatment |
| Requires the patient to communicate that they understand, appreciate, and accept the risks | |
| Requires the healthcare provider to share their knowledge, experience, and advice regarding the medical decision | |
| Requires the healthcare provider to provide information in terms and language the patient can understand |
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What You'll Learn
Patient autonomy and self-determination
The right to refuse medical treatment is a complex area of the law, with conflicting legal precedents, and the validity of refusal depends on the patient's circumstances and reasons for declining treatment. However, the right to refuse treatment is generally based on the common-law right of self-determination of one's body, the ethical principle of autonomy, and the doctrine of informed consent.
Informed Consent
Informed consent is an ethical principle that requires healthcare providers to give patients sufficient information about their diagnosis and treatment options in understandable terms. Once informed consent is given, and a person fully understands the benefits, risks, and alternatives, they have the right to choose any option, including refusing treatment. However, informed consent may be bypassed in emergency situations where immediate treatment is necessary for the patient's life or safety.
Capacity to Refuse Treatment
The right to refuse treatment applies to competent adult patients with decision-making capacity, meaning they are able to understand their medical situation and the consequences of refusing treatment and can communicate their acceptance of the risks. Patients with mental illnesses or intellectual disabilities can still make their own decisions as long as they meet the criteria for informed consent. However, if a patient's illness affects their capacity to refuse care and they pose a danger to themselves or others, healthcare providers may treat them against their wishes.
Limitations and Exceptions
While patient autonomy is generally respected, there are limitations and exceptions. For example, patients under the influence of drugs or alcohol may lack the capacity to make medical decisions, and temporary involuntary treatment may be allowed in such cases. Additionally, patients with communicable diseases may be compelled to undergo treatment or isolation to prevent community harm. Furthermore, parents have limitations in their right to refuse treatment for their children, and court-appointed guardians may make decisions for patients lacking capacity in certain situations.
Advance Directives and End-of-Life Care
The federal Patient Self-Determination Act (PSDA) guarantees Americans the right to refuse life-sustaining treatment at the end of life and mandates that healthcare providers provide information on advance directives, such as do-not-resuscitate (DNR) orders and living wills. This allows individuals to make decisions about their end-of-life care and ensures their autonomy is respected even when they can no longer make decisions.
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Informed consent
The right to refuse medical treatment is a complex area of law, with conflicting legal precedents. The right to refuse treatment is generally based on the common-law right of self-determination of one's body, the ethical principle of respect for autonomy, and the doctrine of informed consent. Informed consent is an ethical principle in which a healthcare provider gives a patient sufficient information about their diagnosis and treatment options in terms that the patient can understand. This includes the benefits, risks, and alternatives to each treatment option, as well as the risks and benefits of refusing treatment. Once informed consent is given, the patient has the right to choose any option, including refusing treatment.
In the United States, the right to refuse treatment has also derived from a federal and state constitutional right to privacy and freedom of religion. The Supreme Court has recognised that the Due Process Clause subsumes a constitutionally protected right to refuse medical care. This includes the right to refuse antipsychotic medication for incarcerated individuals and patients with mental illnesses.
However, there are exceptions to the right to refuse treatment. For example, patients who are deemed mentally incompetent or who pose a threat to the community if left untreated may be compelled to undergo treatment. This includes patients with psychiatric illnesses who are at imminent risk of serious harm to themselves or others. Patients under the influence of drugs or alcohol may also lack the capacity to make their own medical decisions, and treatment may be administered involuntarily in these cases.
In cases where a patient's decision-making capacity is questionable, a physician can give information to a legally appointed guardian or a family member designated by the patient to make decisions on their behalf. Additionally, parents have limitations in their right to refuse medical treatment for their children. While adults who lack decision-making capacity retain the fundamental right to refuse treatment, healthcare professionals are required to respect their refusals except in specific circumstances, such as when there is an imminent threat of serious harm.
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Mental capacity
In England, the Mental Capacity Act (MCA) protects patients who lack the mental capacity to make decisions about their care and treatment. The MCA applies to people aged 16 and over, and covers day-to-day decisions like what to wear, as well as serious life-changing decisions like whether to have major surgery.
Under the MCA, a patient can make an advance statement or advance decision (also known as an advance decision to refuse treatment or ADRT). An advance statement is a general preference about treatment and care, and while it is not legally binding, medical professionals should make an effort to follow the patient's wishes. An advance decision, on the other hand, is legally binding and can be used to refuse specific medical treatment when the patient lacks the mental capacity to decide for themselves. However, health professionals do not have to follow an advance decision if the patient is in hospital under the Mental Health Act.
Doctors must presume that all adult patients have the capacity to make decisions about their treatment. A patient can only be judged to lack capacity to make a specific decision at a specific time, and only after a formal assessment. This assessment must be carried out by a healthcare professional and in line with legal requirements. The patient's carer or healthcare professional will determine whether they require an assessment, and the person who assesses the patient's capacity will depend on the type of decision that needs to be made.
In some cases, patients may lack the capacity to make some decisions but still have the capacity to make others. For example, a patient may lack the capacity to decide on complex financial issues but still have the capacity to decide what items to buy at the local shop. Similarly, a diagnosis of a psychiatric disease does not necessarily mean that a patient lacks the capacity to make decisions. A full assessment of capacity should always be performed for each patient, regardless of their diagnosis.
If a patient is deemed to lack the capacity to make a decision, someone else will make the decision for them. This could be a family member, friend, or carer with Lasting Power of Attorney (LPA), or Enduring Power of Attorney (EPA). If no proxy or advanced directive is available, a healthcare professional and/or an institutionally designated ethics committee will make the decision in the short term, and formal guardianship can be assigned by a court of law if long-term decision-making assistance is required. Any decision made on the patient's behalf must be in their 'best interests'.
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Threat to self or others
The right to refuse medical treatment is a complex area of law, and the validity of refusal depends on the patient's situation and the jurisdiction in which they are being treated. In the United States, the right to refuse treatment is generally based on the common-law right of self-determination of one's body, the ethical principle of autonomy, and the doctrine of informed consent. The Patient Self-Determination Act (PSDA) of 1991 guarantees the right to refuse life-sustaining treatment.
However, there are exceptions to this right. If a patient is experiencing a psychiatric emergency, they may be subject to Emergency Involuntary Procedures if they meet the criteria of being a person in need of treatment, i.e., suffering from a major mental illness and, as a result, are at imminent risk of serious harm or death to themselves or others. The laws regarding these situations vary from state to state, but they typically limit involuntary treatment to situations where the patient is a danger to themselves or others or cannot provide for their basic needs.
In the case of patients who lack decision-making capacity, the right to refuse treatment is retained in most circumstances. However, treatment may be administered without consent in two cases: if the patient has waived their right to refuse in an advance directive (Ulysses Clause), or if there is a court-appointed guardian with the power to consent to treatment. Clinicians must believe that there is an imminent threat of serious harm or death within 24 hours to override the refusal of a patient who lacks capacity.
In the case of minors, courts have generally ordered that blood transfusions be administered in life-threatening cases, overriding the objections of parents based on religious grounds. If the minor is a teenager, joint refusal by the patient and parents would likely be valid.
In summary, while patients generally have the right to refuse medical treatment, there are exceptions when the patient poses a threat to themselves or others. In these cases, the specific laws and procedures vary depending on the jurisdiction and the patient's specific circumstances.
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Religious beliefs
In the United States, the First Amendment protects religious belief, but the state may impose restrictions on practice. This means that, in certain circumstances, a person's religious practices may be curtailed if the state can demonstrate a compelling interest in the preservation or promotion of health, life, safety, or welfare.
Several states have passed laws recognizing the right of patients, including minors, to decline treatment that conflicts with their religious beliefs and practices. For example, in Connecticut, a board of education may require children to be vaccinated before attending a public school, unless a statement from a parent or guardian of the child says that such immunisation would be contrary to the religious beliefs of the child. However, this can lead to personal medical risk, decreases in herd immunity, and outbreaks of preventable diseases. In the case of Stamford Hospital v. Vega, the plaintiff hospital sought an injunction to authorise the administration of a blood transfusion to the defendant patient who had refused to give consent. The issuance of an injunction was found to have violated her common law right of bodily self-determination.
In some cases, the state may step in to protect a child if a parent refuses to provide the child with necessary medical care. For example, the Supreme Court of Pennsylvania has held that the state does not have an interest of sufficient magnitude to outweigh a parent's religious beliefs when the child's life is not immediately imperiled by their physical condition. However, other courts have reached the opposite conclusion, and some parents have been prosecuted for manslaughter when their minor child died because they refused life-saving medical treatment and relied exclusively on divine healing.
The American College of Obstetricians and Gynecologists (ACOG) states that religious refusals should be "limited if they constitute an imposition of religious or moral beliefs on patients, negatively affect a patient's health, are based on scientific misinformation, or create or reinforce racial or socioeconomic inequalities." The Trump-Pence administration's refusal policies have allowed healthcare workers to deny patients services like birth control, abortion, sterilization, hormone therapy, and HPV vaccines, and there are no protections for patients, not even in an emergency.
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Frequently asked questions
Yes, all adults with decision-making capacity have the right to accept or decline medical treatment. This is based on the common-law right of self-determination of one's body and the ethical principle of respect for autonomy. However, there are exceptions, including when patients are deemed mentally incompetent or pose a threat to the community.
Informed consent is an ethical principle in which a healthcare provider gives a patient sufficient information about their diagnosis and treatment options in clear and understandable terms. Once informed consent is given, a person has the right to choose any option, including refusing treatment.
If a patient is deemed incapable of making a decision about their treatment, a court-appointed guardian or a family member designated by the patient can make decisions on their behalf. In some cases, healthcare professionals and/or an ethics committee will make short-term decisions.
Generally, no one can be physically forced to undergo treatment unless they are deemed mentally incompetent or pose a threat to the community. In these cases, healthcare providers may treat the patient against their will, but only to the extent necessary to address the immediate threat.
Parents have limitations in their right to refuse medical treatment for their children. While they can make decisions on behalf of their children, certain procedures may require informed consent from the child as well.
