title: Responding to the refusal of care in the emergency department.
abstract: The emergency department (ED) serves as the primary gateway for acute care and the source of health care of last resort. Emergency physicians are commonly expected to rapidly assess and treat patients with a variety of life-threatening conditions. However, patients do refuse recommended therapy, even when the consequences are significant morbidity and even mortality. This raises the ethical dilemma of how emergency physicians and ED staff can rapidly determine whether patient refusal of treatment recommendations is based on intact decision-making capacity and how to respond in an appropriate manner when the declining of necessary care by the patient is lacking a basis in informed judgment. This article presents a case that illustrates the ethical tensions raised by the refusal of life-sustaining care in the ED and how such situations can be approached in an ethically appropriate manner.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Nelson
authors.forename: Arvind
authors.initials: A
authors.lastname: Venkat
authors.forename: Moira
authors.initials: M
authors.lastname: Davenport
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D002550:Cerebral Veins; D002637:Chest Pain / Q000209:etiology; D059350:Chronic Pain / Q000517:prevention & control; D004636:Emergency Service, Hospital / Q000941:ethics*; D017809:Fatal Outcome; D005260:Female; D021501:Flank Pain / Q000209:etiology; D020773:Headache Disorders / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D009294:Narcotics / Q000627:therapeutic use; D011651:Pulmonary Artery; D016312:Treatment Refusal / Q000941:ethics*; D020246:Venous Thrombosis / Q000188:drug therapy*; D014786:Vision Disorders / Q000209:etiology; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D009294:Narcotics; D014859:Warfarin