Should adults be allowed to refuse to medical care? With what limitations.

[uppityperson]

Poll question: Should adults be allowed to refuse to medical care? With what limitations.

Having had the intense discussion recently about MsRichardson's death, I am wondering what DUers think in general about right to refuse medical care for adults. Children are another topic and more involved, so I am trying to limit this to legal adults who are mentally capable of making legal decisions about themselves.

I am not intending to revisit MsRichardson's death as there are open topics to do so. If you want to talk about her, please go there. This topic is about your, and my, and other adults (assuming we are adults) right to refuse health/medical care.

Should adults be allowed the right to refuse medical or health care in non emergency situations? Should they be allowed the right to refuse in emergency situations? At what point do you feel that right should stop? This could include life and death matters, for example should adults have the right to refuse treatment that could save their lives. This could include mental competency issues, for example once a person at an emergency was unconscious, treatment should or should not automatically begin. This could include following or ignoring someone's Living Will. This could include an adult choosing treatment that others think is not the best for them. This could include an adult refusing to go to a provider when they have an obvious health issue. This could include an adult refusing to even talk with emergency personnel at an accident site.

Who should be allowed the right to refuse treatment, with what limitations? You are king or queen of the universe, how do you think it "should" be?

Again, if you feel the need to turn this into another Richardson or snark thread, please go to the ones that already exist.

[drm604]

1. I chose some limits.

In cases where the adult has some dangerous and easily communicable disease they need to be either treated or isolated.

[ogneopasno]

2. Ah! I hadn't thought of that scenario.

[Nicholas D Wolfwood]

4. I bow to your wisdom on this one.

Good call. Goes to show that there really ARE exceptions to every rule.

[RaleighNCDUer]

10. Yup - that didn't occur to me. Typhoid Mary has no right to say 'no' if

she's going to insist on cooking for the public.

[uppityperson]

11. So isolating someone so they can't spread it and hurt others? Is this what you mean?

For instance, a health care person notices someone at the grocery store coughing and wheezing and hacking and comes to the conclusion they have influenza. They can call the police or EMTs to come take that person to an isolation area to be further assessed and treated rather than spreading the virus amongst the elderly in the community who could, and do, die from it?

A bit extreme case, I agree. But, what limits would be on it?

I agree that public health sometimes takes precedence over personal. But it can be difficult to figure out the limits.

[drm604]

15. I certainly wouldn't agree to snatching someone off of the street simply because they're coughing.

I'm thinking of extreme cases, someone who has been diagnosed with multiple antibiotic resistant TB and won't take their meds, for example. Typhoid Mary is a good historical example. She was a healthy carrier of typhoid and continued to take jobs as a cook after being told not to.

Of course, if we're in the middle of some kind of scifi movie epidemic than isolating people off of the street might be necessary, but that's an extreme case that I think is pretty unlikely.

You're right about the difficulty of setting the limits. In a free society we have to err on the side of freedom and only act in extreme circumstances.

[uppityperson]

17. Appreciate your input on hard questions and issues.

Thanks for taking my question in the spirit it was meant. Way back I had a roommate who had worked, volunteered, at a sanitarium for people with Hansen's disease (leprosy). We had many talks about who should be isolated, etc. It was around the time HIV was appearing more.

[madaboutharry]

3. I would also say with "some limits"

The right to refuse medical treatment should end when it would place others in danger, such as with a communicable disease.

[panader0]

5. I have a living will which states that no extreme measures

should be taken to save me in the event of a serious accident/heart attack/stroke etc. In those cases I would be unconcious. If I am awake, I should be able to refuse any treatment I want to.

[newfie11]

6. Of course they should.

It is a free country (so far) and people should have the right to choose if they want medical care or not. If a person is able to decline medical care that is their decision and no one elses.

[RaleighNCDUer]

7. If a patient is lucid, and understands what the EMT is asking,

that patient has every right to reject treatment. If the patient is dazed or in shock from an injury, then the EMT has a responsibility to continue treatment until the patient is lucid, and able to request they desist. It would be a failure on the EMT's part for the EMT to take him at his word if the patient said "No, no, I'm all right," and then stood up and walked into a wall.

Additionally, if the adult was in a previous lucid state, understood the circumstances and declined treatment for a later time when he would be unable to speak for himself, that previous declining should be respected.

[uppityperson]

18. If someone is lucid, should they be able to refuse talking to EMT?

If an EMT approaches you, should you be able to walk away without speaking to them?

Ethical issues aren't easy.

Edited to add another story. I worked public health yrs back, had a family concerned over an elderly parent not being able to care for self at home any more, and concerned about aging parent's health status. They wanted us to force parent to see a health care provider to see if were really sick, etc. We had to get a court order to do so, needed to give enough info to prove they were possibly not able to make decisions on their own. All the court order was for was to forcefully take the person to a doctor.

[nadinbrzezinski]

22. One note, once pt is no longer lucid, we enter the realm of implied consent

and at that moment medical workers are able to treat

UNLESS there is a DNR or living will.. then it just gets more complex

[uppityperson]

23. Should an adult be able to refuse to talk to an EMT to deterimine if is lucid?

And, who gets to determine if someone is lucid?

[nadinbrzezinski]

24. Yes... having been there done that

even if this is borderline...

Ethically it is a problem...



As to who gets to determine? Unfortunately family at times is your link to whether a pt is lucid or not....

[uppityperson]

8. As OP, I need to give my opinion.

As queen of the universe, I wish everyone would have a Living Will which was respected by all. However, I don't have one. However, everyone in my family is well aware of my wishes and capable of carrying them out.

I think that the only time an adult should lose their Right to Refuse is in the rare instances when they are not capable of making their wishes known and there is no one to whom they have made their wishes known. In a perfect world, we each would have a Living Will, but in this imperfect world, verbal is enough for me.


A friend's parent died of an easily treatable skin cancer which ate away away into the body until we could see ribs exposed because didn't like doctors. My friend and I talked a lot about whether or not this parent could have been forced, should have been forced, to get treatment earlier so as to not die an awful death. Everyone involved ended up traumatized, yet we agreed that the parent was allowed their choice.

We all have worked hard since to try to keep this from happening to anyone else, getting people health care, etc.

People do not always think in the most reasonable fashion, but they have the right to think as they wish, so long as they do not hurt others. I think adults should be allowed the right to refuse treatment, including assessment. It can be very difficult to respect someone else's wishes, but I strongly feel we each have that right.

[ShortnFiery]

9. Yes, of course adults should have full control of their personal medical conditions.

I know that if I was diagnosed with an expensive form of cancer that was terminal (pancreatic), I would opt for the least expensive way to check out of this world second to suicide. Why put your family in GREAT DEBT if you are going to end up dying in a year anyway.

Move to somewhere where the Marijuana laws are real lax and stay high until the Grim Reaper shows up at the doorstep. :evilgrin:

[nadinbrzezinski]

12. Any lucid patient has a right to refuse care

Though I said there are no limits, of course there is one... communicable diseases

There is legal precedent for this, see Epidemic of 1917 as well as TB patients

After that... if you want to refuse care, and you can make that decision, by all means

As to living wills, and DNR's you should know, in some cases if you call 9.11 and there is a DNR, medics have to start CPR

So check with local statues, and this is a moving target

[uppityperson]

13. Having dealt with Public Health issues, I agree, with with limitations.

(copy pasted from above)

For instance, a health care person notices someone at the grocery store coughing and wheezing and hacking and comes to the conclusion they have influenza. They can call the police or EMTs to come take that person to an isolation area to be further assessed and treated rather than spreading the virus amongst the elderly in the community who could, and do, die from it?

A bit extreme case, I agree. But, what limits would be on it?

[nadinbrzezinski]

20. Influenza in that case could be bird flue, a form of influenza

I was talking with BIL yesterday... about that

One benefit of single payer health care is that PT with influenza may see the doctor early and triaged early into quarantine, in that case

In my case, triaged to die... I know the system and due to medical hx no way, no how, anybody would waste the resources

So extreme, perhaps not so much

:-)

Bird flu, epidemic of 1917, same story... different decade

And we are overdue

:hi:

[damntexdem]

14. Some limits -- e.g., having the capacity to choose, being fully informed, etc.

Most important: not if they have a highly-contagious disease, or dangerous disease with lower threat of contagion (e.g., antibiotic-resistant TB).

[haele]

16. Some limits - if they have a highly contagious disease -

- especially if they insist on being out in public with that disease, or if they're mentally incapable of making a competent decision on their own medical condition.
People who are in great pain, great fear or who have serious medical issues (head injuries or high fever)aren't able to think clearly enough to say "I want treatment" or "This is going to be too much for X, Y, or Z reasons (mainly, treatment won't fix anything, and I'm going to die or not be functional anyway), so could you just help me go peacefully..."
The problem with having limits on the patient's ability to agree or disagree with treatment is that even if all the medical or social professionals believe wholeheartedly that the patient must have the treatment, the treatment plan is not always in the best interest of the patient.

To me, the only real limit should be a matter of public health.

Haele

[sinkingfeeling]

19. I am the only person on the planet with a right to accept or refuse medical treatment for myself.

That is why I still haven't accepted radiation treatment. I have a 'living will' to cover the situations when I'm not conscience.

[soothsayer]

21. EFF the nanny state

[mnhtnbb]

25. My father had a living will and he exercised his right to refuse food.

He was 91, confined to a wheel chair, had trouble eating without help, could no longer figure out how to
turn the TV on/off or change channels, push the button for CD/tape player, or choose to read a magazine, book or newspaper. He required 24 hr care for a postoperative dementia. Sometimes he knew his wife had died and sometimes he thought the woman down the hall was his wife. Hubby and I had left town on a Friday to go to Chicago (I had told him we were going for the weekend)and I got a call from the nursing home telling me he was refusing to eat and wanting to put in a feeding tube. I told them, "absolutely not". My father decided he'd had enough and we honored his wishes. He died peacefully the following Tuesday.

Was it easy letting him go? No. But I firmly believe he had the right--which he'd legally asserted in advance when he was still 'with it'-- to stop eating. He became comatose within 24 hours and he regained consciousness for a few brief minutes before he died.

[uppityperson]

26. kick for the night crew, or day crew, as the case may be.

thank you all who voted and who replied.

[Naturyl]

27. Yes, of course.

The idea of having no choice over what is done to one's own body is about is frightening as it gets.

Why would anyone consider voting no?

[and-justice-for-all]

28. Yes, adults have the right to refuse treatment...

unless they are a danger to others.