A patient refusing medical transport or care can be a stressful situation for all involved. It’s essential that EMS providers be aware of the applicable laws and protocols to avoid confusing and even dangerous situations for both the patient and provider.
The Department of Transportation has set forth the standards for EMS since 1970. These standards state that all patients have the right to accept or refuse care after being informed about the care to be provided and the accompanying risks. In other words, a patient refusal is intended to be the result of an informed decision. This is an application of the concept of informed consent that has become universal to all healthcare providers.
There is one important exception to the patient right of refusal: in an emergency situation where the patient is incapacitated, the EMS provider may treat him or her with emergency care based on the assumption that under the circumstances a normal person would consent. This is known as the doctrine of implied consent.
There are two major issues that can muddy the waters when it comes to a patient’s ability to give informed consent: capacity to make decisions and age. Generally, an individual is considered capable of making an informed decision if they are able to understand the benefits and risks of both the proposed treatment and no treatment. This is simple enough in theory, but in practice it can be an extremely difficult evaluation to make in the field. For a patient to be judged incapacitated (in which case implied consent would kick in), it must be an emergency situation and two conditions must be met. First, the patient is incapacitated due to shock or trauma and is unable to make an informed decision. Secondly, a life-threatening disease or injury that requires immediate treatment must be present where further delay would result in death or impairment. If these requirements are met, the EMS provider can suspend the doctrine of informed consent and transport the patient even if this is against the patient’s wishes.