Can ER patients refuse treatment?

[itku2er]

Well I was always under the impresson that the patient has the right to choose or deny any treatment as long as they are compent enough to make that choice. Of course he will walk away with ALOT of $$$$$$$$ and the general public will never know how much either probally. Why did he spend time in the detention center unless he knocked the crap out of the md that did the exam. The story said he charges were dropped for assult and battery.

ummmmmm

[gvandellen]

I think that dropping the charges will work in the favor of the MD's. Think about it. Why would a judge think that A&B on a MD would be allowed??? Because he wasn't in his right mind and if he wasn't in his right mind then he couldn't refuse a test...Catch 22

[ERDoc]

ATLS preaches the rectal exam and the old surgical mantra "a tube or finger in every hole." Multiple studies have shown that the rectal may be a relatively useless test. I'm not a big fan of it in most cases as I feel it doesn't change the management or provide any additional information. Again, it is taught in ATLS so you have to keep in mind that it is part of the surgical mentality.

A pt that is competent has the right to refuse anything they want, including a rectal exam. Just because it is part of the workup does not mean you can force it on the pt. If they say no (and have the capacity to do so) then it is no. Period.

There are a few things about this case that just do not make sense. It is probably from the uneducated media trying to report the facts. If this guy got RSI'd, then a rectal exam is useless except to look for blood (no likely to find it in a head injury). I also heard that the doctor filed a case against the guy. So, the doctor thinks the guy is competent enough to be responsible for his actions but no competent to make the decision not to have a rectal exam. You can't have it both ways. He either had the capacity or not, which is it doc? I think there are too many facts left out for us Monday morning quarterbacks to make a real decision.

I also think the pt is a tool. He now has PTSD? WTF? If he was RSI's he is not going to remember the rectal. Maybe his rights were violated, but come on, get a life.

Pretty messed up situation all around, but hard to draw a true conclusions due to the lack of facts from the media.

Thread Hijack: The assault thing brings up another interesting discussion for those of us in medicine. If a cop is assaulted in the line of duty the person will go to jail. If one of us is assaulted, the courts will shrug it off saying it is part of the job. I think that pretty much sucks. If it is someone who has been injured or is sick and not ini their right mental state then I would agree. However, if someone is drunk or high then no, it should not be part of the job. They should be prosecuted just like they would if they did it to a cop. I'll step off my soapbox now and return you to your regularly scheduled thread.

[spenac]

I also think the pt is a tool. He now has PTSD? WTF? If he was RSI's he is not going to remember the rectal. Maybe his rights were violated, but come on, get a life.

Perhaps RSI not done correctly. Seen a doc forget versed and just hit patient with the sucs. Poor little old person.

[MSDeltaFlt]

I may not be legally savy in every state, however, if you are 18 or older, or an emancipated minor, Conscious/Alert/Oriented to at least 3 of the following: person/place/time/events, verbally appropriate, AND not a danger to yourself and/or to others, then you have the right to refuse just about anything you wish.

Any deviation in the above, as patient advocates, you WILL lose your right to refuse.

Due to HIPAA regulations, we do not have the complete story here, for we were not there.

With respect.

[ERDoc]

I may not be legally savy in every state, however, if you are 18 or older, or an emancipated minor, Conscious/Alert/Oriented to at least 3 of the following: person/place/time/events, verbally appropriate, AND not a danger to yourself and/or to others, then you have the right to refuse just about anything you wish.

Any deviation in the above, as patient advocates, you WILL lose your right to refuse.

Due to HIPAA regulations, we do not have the complete story here, for we were not there.

With respect.

That is not exactly true. The person has to have the ability to understand the consequences of their refusal of care. This is part of having the capacity to refuse. A mentally retarted person can be all of the above but may not be able to understand the consequences of refusing a procedure so they cannot make an informed refusal of care.

[MSDeltaFlt]

You're right. I thought I forgot to add something. Thanks.

[Eydawn]

Whoopsie! Got some misconceptions going on here about the legal status of adults with developmental disabilities. Here's how it works folks... REGARDLESS of deficit, the day you turn 18 you are considered your own legal guardian. Which means that if you refuse care, you refuse care, whether or not you fully understand the refusal...

NOW, for those individuals lucky enough to have guardians appointed for them (either involved family members or a court appointed guardian) the guardians get to make the medical decisions.

It is unfortunate but true, that there are people who really shouldn't be their own guardians due to a lack of capacity, but who nonetheless are. Which means, even though they have an IQ of 30, and cannot understand the ramifications of medical procedures, if they meet the criteria of alert and aware, they CAN LEGALLY REFUSE your treatment. End of story.

Now... granted, there are a LOT of people with really low IQ's who won't meet the refusal criteria, but there are also a lot who compensate *extremely* well and will, and if you force treatment on them you will be guilty of assault.

I can provide legal references for any interested! Since that's what the future hubby's job is right now (case managing adults with DD) he knows the laws regarding rights of refusal like the back of his hand...

Wendy

CO EMT-B

[ERDoc]

Whoopsie! Got some misconceptions going on here about the legal status of adults with developmental disabilities. Here's how it works folks... REGARDLESS of deficit, the day you turn 18 you are considered your own legal guardian. Which means that if you refuse care, you refuse care, whether or not you fully understand the refusal...

NOW, for those individuals lucky enough to have guardians appointed for them (either involved family members or a court appointed guardian) the guardians get to make the medical decisions.

It is unfortunate but true, that there are people who really shouldn't be their own guardians due to a lack of capacity, but who nonetheless are. Which means, even though they have an IQ of 30, and cannot understand the ramifications of medical procedures, if they meet the criteria of alert and aware, they CAN LEGALLY REFUSE your treatment. End of story.

Now... granted, there are a LOT of people with really low IQ's who won't meet the refusal criteria, but there are also a lot who compensate *extremely* well and will, and if you force treatment on them you will be guilty of assault.

I can provide legal references for any interested! Since that's what the future hubby's job is right now (case managing adults with DD) he knows the laws regarding rights of refusal like the back of his hand...

Wendy

CO EMT-B

I'd like to see the legal cases, because I respectfully disagree with you. The person has to be able to make an informed decision and if they cannot understand the ramifications they cannot consent or refuse.

Edit: Here is the law from Louisiana:

1299.58. Consent to surgical or medical treatment for mentally retarded or developmentally disabled persons and residents of state-operated nursing homes - [top]

A. Upon the written recommendation of the treating physician, the following persons may consent to any surgical or medical treatment on behalf of any mentally retarded or developmentally disabled person who is a recipient of service from a state-operated supported living or supervised independent living program, or personal care attendant program for the mentally retarded or developmentally disabled, or who is a resident of a state school or community home for the mentally retarded or developmentally disabled, state- supervised extended family living program, or a nonstate-operated residential facility, community, or group home for the mentally retarded or developmentally disabled or who is a resident of a state-operated nursing home:

(1) For a resident of a state school or a state-operated community home for the mentally retarded, the superintendent of the state school.

(2) For a resident of a state-supervised extended family living program, or a recipient of service from a state-operated supported living or supervised independent living program, or personal care attendant program for the mentally retarded or developmentally disabled, the office for citizens with developmental disabilities administrator or manager with administrative authority over the extended family living program, supported living or supervised independent living program, or personal care attendant program for the region where the home is located or the program is being provided.

(3) For a resident of a nonstate-operated residential facility, community, or group home for the mentally retarded, the chief executive officer of the provider organization which administers or operates the facility or home.

(4) For a resident of a state-operated nursing home, the administrator of the home or facility.

B. Consent for any surgical or medical treatment on behalf of a mentally retarded person or a resident in a facility, home, or program as described in R.S. 40:1299.58(A) is authorized under the following circumstances:

(1) When all reasonable efforts to contact the parent, family, or guardian of the resident have failed or

(2) When the resident's record does not contain the name of the parent, family member, or guardian.

C. Consent given pursuant to this Section shall be in writing and shall comply with the provisions of R.S. 40:1299.40(A). A copy of the signed written consent form and of the physician's written recommendation shall be placed in the resident's permanent record.

D. Nothing contained in this Section shall be construed to authorize consent to surgical or medical treatment for a resident if the parent, family member, or guardian of the resident has been contacted and has refused to consent to medical treatment for the resident.

E. Consent to surgical or medical treatment for residents will be implied where an emergency, as defined in R.S. 40:1299.54, exists.

F. As used in this Section, mentally retarded includes the developmentally disabled.

Added by Acts 1978, No. 607,§ 2; Acts 1990, No. 177,§ 1; Acts 2001, No. 519,§ 1.

[ERDoc]

From emedicinehealth.com:

Components of Informed Consent

There are 4 components of informed consent:

You must have the capacity (or ability) to make the decision.

The medical provider must disclose information on the treatment, test, or procedure in question, including the expected benefits and risks, and the likelihood (or probability) that the benefits and risks will occur.

You must comprehend the relevant information.

You must voluntarily grant consent, without coercion or duress.

Decision-Making Capacity

Decision-making capacity is often referred to by the legal term competency. It is one of the most important components of informed consent. Decision-making capacity is not black and white. You may have the capacity to make some decisions, but not others.

The components of decision-making capacity are as follows:

The ability to understand the options

The ability to understand the consequences of choosing each of the options

The ability to evaluate the personal cost and benefit of each of the consequences and relate them to your own set of values and priorities

If you are not able to do all of the components, family members, court-appointed guardians, or others (as determined by state law) may act as "surrogate decision-makers" and make decisions for you.

To have decision-making capacity does not mean that you, as the patient, will always make "good" decisions, or decisions that your doctor agrees with. Likewise, making a "bad" decision does not mean that you, as patient, are "incompetent" or do not have decision-making capacity.

Decision-making capacity, or competency, simply means that you can understand and explain the options, their implications, and give a rational reason why you would decide on a particular option instead of the others

Informed Consent, The Right to Refuse Treatment

Except for legally authorized involuntary treatment, patients who are legally competent to make medical decisions and who are judged by health care providers to have decision-making capacity have the legal and moral right to refuse any or all treatment. This is true even if the patient chooses to make a "bad decision" that may result in serious disability or even death.

To document that you have been given the option of obtaining a recommended treatment or test and have chosen not to, you may be asked to sign an Against Medical Advice (AMA) form to protect the health care provider from legal liability for not providing the disputed treatment. Refusing a test, treatment, or procedure does not necessarily mean that you are refusing all care. The next best treatment should always be offered to anyone who refuses the recommended care.

If, because of intoxication, injury, illness, emotional stress, or other reason, a health care provider decides that a patient does not have decision-making capacity, the patient may not be able to refuse treatment. The law presumes that the average reasonable person would consent to treatment in most emergencies to prevent permanent disability or death.

Advance directives and living wills are documents that you can complete before an emergency occurs. These legal documents direct doctors and other health care providers as to what specific treatments you want, or do not want, should illness or injury prevent you from having decision-making capacity.

With all due respect Eyedawn, your significant other may want to review the law before he gets himself into a sticky legal situation.