Your Right to Refuse Medical Treatment

You have a right to refuse medical treatment at all times! I find myself telling my patient’s this everyday that I go to work. It is so important and that is why I advocate for my patients to speak up and say no if they don’t agree with something. Many people see their medical provider as an authority so they will do whatever they tell them. No matter how much your doctor or provider might tell you that you need something you can always say NO! If it doesn’t sit well with you or doesn’t make sense to you tell them to stop and give you more information to make the right decision. It is your body and your right to do with it as you choose.

After hearing many women’s stories about something being done to them during their pregnancy that they did not consent to I knew I needed to write about your right to refuse medical treatment. In this day and age I think it is more important than ever to understand your rights and be prepared to speak up for yourself.

What is Informed Consent?

As a patient you have a right to make an informed, voluntary decision about your care. Informed consent is a process in which a medical provider is required to educate a patient about the risks, benefits, and alternative treatments to a given procedure or intervention. Informed consent is an ethical and legal obligation of all medical practitioners in the US.

Exceptions to the Right to Refuse:

• Altered Mental Status: if you are altered due to alcohol, drugs, brain injury, mental illness, or medical condition. In this case the physician would need to get consent from a legally appointed guardian or family member designated to make decisions for the patient.
• Children: A parent or guardian cannot refuse life-sustaining treatment or deny medical care from a child. This includes those with religious beliefs that discourage certain medical treatments. Parents cannot invoke their right to religious freedom to refuse treatment for a child.
• A threat to the community: If your refusal of medical treatment is a threat to the community. If you are a physical threat to others due to mental illness you may not refuse treatment. If you have a communicable disease you would be required to isolate and be treated to prevent spread to the general public.
• Emergency: informed consent may be bypassed if immediate treatment is necessary to save a patient’s life or for safety.

What is Implied Consent?

Implied consent is based upon a person’s actions. If you show up at your doctor’s office asking for a flu shot and roll up your sleeve that implies that you agree to get a shot. The same applies if a phlebotomist asks to draw your blood and you roll up your sleeve. You are indicating that you agree to the treatment requested. This does not require any verbal or written consent like other procedures.

If you came in to your doctors office for a physical exam and they then determine that they would like to do an invasive procedure at that time that was not previously discussed they must get your consent before proceeding. You should have the chance to refuse medical treatment if you don’t want that skin biopsy or vaccine.

Why is Knowing How to Advocate For Yourself So Important?

The news will tell you we are currently experiencing a nursing shortage. This is incorrect. Nursing schools are pumping out new nurses faster than ever. Most ICUs and ERs are 50% or more new graduate nurses or travel nurses. A lot of nurses are leaving their bedside nursing jobs for other settings or leaving the profession altogether. The real problem our healthcare system is facing is that after several years of a global pandemic, nurses and other healthcare providers are no longer willing to work in toxic, unsafe work environments. I myself have taken a huge step back from my bedside role due to constant preshift anxiety and a few episodes of anxiety attacks. Since taking a step back from my full time schedule my anxiety has almost disappeared.

So what does that mean for the everyday healthcare consumer. You need to be prepared to speak up. Not because our healthcare providers (Doctors, PAs, nurses, respiratory therapists, physical therapists, CNAs, or other staff) don’t know what they are doing, but because they are under such unspeakable ratios and stresses that they do not have the time to give you that you deserve. They are human beings and what is being asked of them is really unsustainable. They don’t have the time to advocate for you. You have to be aware of what is happening and advocate for yourself. It’s not because we don’t care. We just literally can not do it all.

How do I Talk to My Doctor?

What if your doctor advises you get a certain procedure or treatment and you aren’t sure it is right for you.

Example: Doctor wants to perform membrane sweep at next appointment to help induce labor

• Express to them that you appreciate their professional opinion and their time. Next explain to them that you need some clarification about the procedure or treatment
  • “Can you explain why in your professional opinion this would be the best option for me versus waiting for labor to occur on it’s own?”
• explain to them that you need some clarification about the procedure or treatment. Make sure you are prepared with specific questions as their time is very valuable.
  • “Can you please walk me through what the procedure will look like so I can feel prepared? What should I expect to see after the procedure?”
• Repeat back to them what you understand they are saying to confirm you have a correct understanding?
  • “From what I understand you are saying that in your experience birth complications and risks increase after the 39th week so you would like to try membrane sweeping to help push me into spontaneous labor prior to scheduling an induction?”
• If you still don’t feel good about that option ask about alternative treatments.
  • “I really don’t feel comfortable with that treatment what are my other options?”

At the end of the day this will help you either understand why this is the right treatment for you or give you the confidence to say I know forgoing this procedure is the right thing for me. At the end of the day it is your body and your life. You have a right to refuse medical treatment at any time even if you previously consented.

But It’s Hospital Policy?

I have heard people say, “I thought I didn’t have a choice” or “they told me it was hospital policy.” The hospital may have policies that they have implemented based on their safety concerns, but you are not restricted by their policies when it comes to your choice to refuse medical treatment. You can let your provider know that they are free to note it in their documentation that you are refusing that particular treatment.

What Types of Things Require Consent?

Every medical treatment and intervention requires consent whether it is implied or given. Typically you will need to provide written consent for:

• Most surgeries
• Endoscopies
• Anesthesia
• Blood transfusions
• chemotherapy and radiation
• Biopsies
• HIV testing
• Most vaccinations
• High risk medical treatments

All other forms of treatment require either verbal or implied consent based on your actions.

Conclusion

In as many medical situations as possible try to come prepared. Reach out to your provider in advance. Many have online portals that you can message their nurse with any questions or concerns that you have prior to your appointment. Be an active participant in your care. If they use language that you don’t understand (because medical terminology is a whole different language) ask them to explain it in simpler terms. Make sure you understand the procedure, benefits, risk, and alternative treatment options before making a decision. At the end of the day if it doesn’t feel right SAY SOMETHING. You cannot rely on someone else to take the driver’s seat in your healthcare. And remember you have a right to refuse medical treatment at any time.