Elsevier

Annals of Emergency Medicine

Volume 17, Issue 9, September 1988, Pages 957-963
Annals of Emergency Medicine

Case conference
Prehospital patients refusing care

https://doi.org/10.1016/S0196-0644(88)80679-6Get rights and content

Summary

Dr Shalit: In summary, many of the complex medicolegal and ethical issues surrounding the prehospital patient who refuses all or part of the care offered by the EMS system have been reviewed. The best outcome can be achieved using a sliding scale of capacity and a conservative approach to treatment rather than releasing the patient at the scene. Finally, the roles of collateral history, inquiries as to the origin of the patient's refusal of care, direct physician interaction with the patient, a spirit of creativity and compromise in dealing with the patient, meticulous documentation, and policy issues have been discussed.

References (22)

  • SelbstS

    Leaving against medical advice

    Pediatr Emer Care

    (1986)
  • Cited by (36)

    • The Diagnosis and Management of Seizures and Status Epilepticus in the Prehospital Setting

      2011, Emergency Medicine Clinics of North America
      Citation Excerpt :

      Such patients must demonstrate to providers the mental capacity to make an informed medical decision to refuse care. In patients who have just had a seizure, it is unlikely that they will demonstrate intact mental status and capacity for medical decision making.12,13 Because the risk of seizure recurrence is approximately 6%, prehospital care providers and medical command physicians should ensure that patients understand the risks of refusal.14

    • Risk Management for the Emergency Physician: Competency and Decision-Making Capacity, Informed Consent, and Refusal of Care Against Medical Advice

      2009, Emergency Medicine Clinics of North America
      Citation Excerpt :

      Wear4 and Wicclair6 believe that the assessment of a patient's capability to make an informed treatment decision can be decoupled from the patient's final treatment decision. There is a theory of sliding-scale capacity that links the treatment decision rationale to the process used to reach the final treatment decision.1,7–9 In essence, this theory holds patients who choose a riskier treatment option to a higher standard of competency by requiring the patient to demonstrate greater clarity in explaining the rationale behind the choice of the higher risk treatment option.10

    • Refusal of Care: The Physician-Patient Relationship and Decisionmaking Capacity

      2007, Annals of Emergency Medicine
      Citation Excerpt :

      Wicclair6 adopts a similar position.) Most commentators do not agree with Wear5 and Wicclair,6 arguing that the decision made by the patient is directly relevant to the assessment carried out.1,3,7-9 Patients considering a risky treatment, even if they agree, and patients who refuse care (who are presumably choosing a more risky option) should be held to a higher standard when their capacity is determined, which is often referred to as the “sliding scale” of capacity.

    View all citing articles on Scopus
    View full text