Can I Refuse Care?

Goal of Patient Care: When you are a patient in the health care setting, it is important for you to realize that the members of your health care team have your best interests at heart. Your absolute safety and security is the ultimate goal of all patient care and the mantra of your health care team is to do “no harm”. While that is the goal, you have only to read a newspaper or listen to the local news to hear stories of health care gone bad, at times with catastrophic consequences to the patient.

Before Refusing Care: With that being said, you have the perfect right to refuse treatment, procedures, medication, or diagnostic testing at any time. Before refusing such care, however, you must be able to evaluate the consequences of that decision. This means that you need to understand the need for the specific drug, test, procedure or treatment that your health team is recommending. If you feel you don’t have enough information to make good decisions about that care, ask for more information. If you don’t understand the explanations given to you by your health care team, ask for clarification. Ask for the definition and spelling of unknown medical terminology. Ask for written literature about recommended care. Ask the doctor what s/he is going to do with the results of the recommended test or procedure. Ask about the person who is going to perform the procedure or test. Find out how many times s/he has performed it. Try and determine that person’s competency by asking about the rate of complications. Ask why you need a particular drug, procedure or treatment. Ask about the consequences if you refuse such care.

Consequences of Refusing Care: You must be aware that refusing care on a regular basis may interfere with finding out what is wrong with you (making a diagnosis) and treating you to make you well. Refusing care can reduce your probability for a complete recovery (prognosis). In addition, the hospital will need to report your repeated refusal of care to your health insurance company (or Medicare or Medicaid) and that organization may refuse to pay for your continued hospitalization. After all, why should they pay for your hospitalization when you regularly refuse care?

Signing Yourself Out Against Medical Advice: Unless you are a mental health patient or an actual prisoner requiring hospitalization, you can sign yourself out against medical advice at any time. If you choose to do this, however, expect your health care team to talk with you to try and find out why you want to leave. Be prepared for that conversation. They want to be assured that you understand the potential consequences of leaving the hospital against medical advice. They will ask you to sign an AMA (Against Medical Advice) Form. This form negates their liability in the event that something catastrophic happens to you when you choose to leave against medical advice. If you refuse to sign it, two members of the health care team will witness and document that you refused to sign it. If the health care team feels that you are incapable of understanding the consequences of leaving the hospital AMA, they can physically restrain you and call for a psychiatric evaluation to determine whether or not you are capable of making such a decision for yourself.

The key is to communicate with your health care team. Let them know what you are feeling and thinking. Let them know your concerns. Ask them any questions you might have. Ask for clarification whenever you are in doubt. Be assertive. Advocate for yourself. You have a voice…use it!

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