Can I Refuse Care?

Charlotte Jewish News August 2021

Lorrie Klemons, MSN, RN, CDP

When you are a patient, it is important you realize that the members of your health-care team have your best interests at heart. Your absolute safety and security are the ultimate goal of all patient care, and the mantra of your health-care team is to do “no harm.” While that is the goal, you have only to read a newspaper or listen to the local news to hear stories of health care gone awry, at times with catastrophic consequences to the patient.

That said, you have the absolute right to refuse treatment, procedures, medication, or diagnostic testing at any time. Before refusing such care, however, you must be able to evaluate the consequences of that decision. This means you need to understand the need for the specific drug, test, or procedure that your health team is recommending. If you feel you don’t have enough information to make sound decisions about that care, ask your health-care team for more information.

If you haven’t understood the explanations given to you by your health-care team, ask for clarification.

• Ask for the definition and spelling of unknown medical terminology.

• Ask for written literature about recommended care. Ask the doctor what he or she is going to do with the results of the recommended test or procedure.

• Ask who is going to perform it.

• Ask how many times she or he has previously performed it.

• Ask why you need a particular drug, procedure, or treatment.

• Ask about the potential side effects of prescribed drugs. Do the benefits of taking the drug outweigh not taking it?

• Ask about the consequences if you refuse such care.

• Always explain why you are

refusing treatment so that your rationale for refusal becomes part of your medical records. Otherwise, you risk being labeled an uncooperative patient. Though it is your right to refuse care, you need to know that doing so regularly might interfere with finding out what is wrong with you (making a diagnosis) and with the ultimate outcome of your situation (prognosis). In addition, the hospital will be required to report your repeated refusals of care to your health insurance company (private, Medicare, or Medicaid), and that company may refuse to pay for your continued hospitalization. After all, why should it pay for you to be in the hospital to get care that you refuse?

Unless you are mentally incompetent to understand the consequences of refusing treatment, or are an actual prisoner requiring hospitalization, you can sign yourself out at any time.

If you choose to leave against medical advice (AMA), expect your health-care team to talk with you to find out why you want to leave. Be prepared for that conversation. The team wants to be assured that you understand the potential consequences of leaving the hospital against medical advice. It will ask you to sign an AMA form. This form negates the staff’s liability in the event that something catastrophic happens to you after you leave. If you refuse to sign it, two members of the healthcare team will witness and document that you refused to sign it. If the health-care team feels you are incapable of understanding the consequences of leaving the hospital AMA, it can restrain you and call for a psychiatric evaluation to determine whether you are capable of making such a decision for yourself.

The key is to communicate with your health-care team consistently. Let the staff know what you are feeling and thinking. Let the team know your concerns. Ask any questions you might have.

• Ask for clarification whenever you are in doubt.

• Be assertive.

• Advocate for yourself or have an advocate with you who can make sure your voice is heard when you might not have one.