Retrieved from : https://www.acep.org/Clinical---Practice-Management/Code-of-Ethics-for-Emergency-Physicians/

CASE 4 Responding to the Refusal of Care in the Emergency Department By Jennifer Nelson, Arvind Venkat, Moira Davenport 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. Keywords: Decision-making Capacity, Emergency Department, Emergency Physician, Informed Consent, Treatment Refusal Link to Case: Reflection Questions: 1. Does coming to the Emergency Department constitute implied consent to treatment? Why would a patient come to the ED if not to receive potentially life-sustaining treatments at a physician's recommendation? 2. If it is evident that a patient lacks decision-making capacity, is it paternalistic to administer life-saving treatment even if the patient refuses? 3. In this case, would it be ethically appropriate for the physicians to consult the patient's family, in order to bring in one more agent of authority? Web Resources: Cooper, S. (2010). Taking No for an Answer-Refusal of Life-Sustaining Treatment. AMA Journal of Ethics/Virtual Mentor. Retrieved from: http://journalofethics.ama-assn.org/2010/06/ccas2- 1006.html ACEP Code of Ethics for Emergency Physicians. (2008). Retrieved from: https://www.acep.org/Clinical---Practice-Management/Code-of-Ethics-for-Emergency-Physicians/