Oncology patients in the emergency room: Refusal of treatment in the hospital setting

WHEN A PATIENT is seen in the emergency room with a medical condition requiring admission but refuses treatment on an inpatient basis, the physician may feel placed in a precarious position. The physician must analyze the medical needs of the patient and consider important legal and ethical ramifications. Each refusal requires evaluation on a case-by-case basis. Decision-making criteria will vary depending on (1) the patient's competency to make health care decisions, (2) the presence or absence of a durable power of attorney for health care decision-making, and (3) whether the patient's clinical presentation constitutes an emergency medical condition. We attempt to provide a framework for medical decision-making in such challenging situations. To assist clinicians in maintaining a balance between the patient's medical needs and the patient's right to refuse care, several alternatives to inpatient clinical management are presented for consideration.