Do Patients Have the Right to Refuse Medical Treatment?

Informed Consent and the Right to Refuse

The right to refuse treatment goes hand in hand with another concept known as the right to informed consent. 

To meet the criteria for informed consent, the patient must receive and understand five things:

• The diagnosis
• The proposed treatment
• The risks and benefits of the treatment
• Alternative treatments and their risks and benefits
• The risks and benefits of declining treatment

This must be done without pressure or coercion (meaning persuading someone to act against their free will).

Coercion can be negative, such as screaming at someone or purposefully omitting information. Coercion can also be positive, such as slanting information to encourage treatment or incentivizing a person to undergo treatment.

For most medical treatments, informed consent does not need to be written. The only exception is for research (such as clinical trials) in which informed consent must be documented and signed off by the patient before treatment can be dispensed.

It is unethical to force or coerce someone into treatment if they are of sound mind and mentally capable of making an informed choice. This includes people with mental illness or intellectual disabilities who still have the right to refuse treatment until they are deemed legally incompetent.

Exceptions

In emergencies, healthcare providers may bypass informed consent if immediate treatment is necessary to save their lives. If the emergency responders are unaware of or do not have access to legal decrees—such as a do not resuscitate (DNR) order—they can deliver treatment without legal repercussions.

There are other instances in which a person cannot refuse treatment even in non-emergency situations.

Mental Incompetence

People may not have the right to refuse treatment if they have an altered mental state, also known as mental incompetence. Mental incompetence may be due to alcohol and drugs, brain injury, or psychiatric illness.

Under the Mental Capacity Act 2005, a mentally incompetent person is someone who lacks the mental capacity to conduct or manage their affairs due to an injury or disease. It is a broad definition that requires legal intervention and the appointment of a legal guardian or conservator.

Having a serious mental illness like schizophrenia or an intellectual disability (such as caused by Down syndrome) does not automatically mean a person is incompetent.

So long as the criteria for informed consent can be met, these individuals can make their own decisions unless someone steps in and legally challenges them.

Children and Minors

Typically, state laws give parents a lot of leeway in providing consent for or refusing medical care. But this isn’t always the case if the decision endangers a child’s life.

A parent or legal guardian may not refuse life-sustaining treatment or deny medical care for a child even if their religious beliefs discourage such treatments. This means parents cannot invoke their right to religious freedom to refuse treatment for an ill child.

In situations like this, criminal prosecution and/or the loss of custody of the child might occur.

Even so, there are broad interpretations of parental rights, and the interpretations can vary by state. In some states, courts will allow a child protection agency to make medical decisions for a child if the following four conditions are met:

• The parents refuse consent.
• The child would die without the treatment.
• Doctors qualified to treat the child are in agreement about the treatment.
• The treatment will afford the child a relatively normal life with a reasonably good quality of life.
  

Treatment can be refused by parents if these four conditions are not met. For example, if the child has a terminal illness and treatments are no longer beneficial, the parents have the right to refuse treatment and seek hospice care for their child.

Depending on the state, the parental right to consent or refuse treatment might extend to children under 18 years of age. In some states, a "non-minor" child may make their own decision if they are 16 or 17 years of age or older.

Threat to the Community

A person's right to refuse medical treatment may be denied if the lack of treatment seriously threatens the community.

For example, some communicable diseases require vaccination or quarantine to prevent the spread to the general public. (Communicable diseases differ from the larger category of infectious diseases, some of which may be spread through things like sex or injecting drug use that don't pose a public health threat.)

Mandatory vaccination can be imposed in school districts where a child may not be refused attendance if they don't get vaccinations such as DTaP (diphtheria, tetanus, and pertussis) and MMR (measles, mumps, and rubella).

Some states and institutions also mandate vaccination for healthcare workers to prevent the spread of COVID-19, flu, and hepatitis B in hospitals and care facilities.

In terms of actual treatment, a court may order medical and psychiatric treatment for people who have been convicted of a drug- or alcohol-related crime. Mandatory treatment may also be imposed if someone with a mental illness is violent and poses a physical threat to themself or others.

Immigrants wanting to reside in the United States may also be mandated vaccinations and treatments to legally obtain a visa or Green Card. Examples include the treatment for tuberculosis if a positive TB test is received.

Non-Life-Threatening Treatment

Most people in the United States have a right to refuse care if treatment is for a non-life-threatening illness. This may include not getting a prescription filled, not getting a flu shot, or deciding to stop using crutches after you sprained an ankle.

Others refuse treatment for emotional reasons, such as the fear of drug side effects, the fear of anesthesia and surgery, or the fear of disclosure of a disease like HIV.

Either way, there is nothing illegal about choosing to forego treatment for any reason. They are personal choices that you have the right to make even if others don't agree with you.

End-of-Life-Care Refusal

Some people choose to refuse treatment at the end of their lives. Under the Patient Self-Determination Act (PDSA) of 1991, people are guaranteed the right to refuse life-sustaining treatment in such circumstances.

The PSDA also mandated nursing homes, home health agencies, and HMOs to provide patients with information regarding advance directives which allow them to direct their own medical care if they become incapacitated.

These include:

• Living wills
• Do not resuscitate (DNR) orders
  
• Physician’s orders for life-sustaining treatment (POLST)

There are many reasons for an advanced directive. Some people simply do not others making decisions on their behalf when they are no longer able to do so themselves. Others may not want emergency interventions that can prolong their life and leave their loved ones burdened with medical bills.

Another way for your wishes to be honored is to have a medical power of attorney. This document designates the person or persons who can make decisions on your behalf if you are mentally incompetent or severely incapacitated and can no longer make decisions for yourself.

Knowing and Using Your Rights

If you are struggling to make a medical decision consider working with a patient advocate who is trained in patient rights and whose job is to focus on your interests and your interests alone.

Working with a patient advocate can help you articulate your values, beliefs, and intentions and decide which actions can be taken within the law to ensure your wishes are followed.

If needed, a lawyer may be needed if someone is trying to step in and take control of your medical decisions, Examples include a son or daughter who thinks you are "too old" to make decisions or a loved one who is challenging a medical decision made by someone with a mental illness.