Key takeaways

  • With informed consent, you generally have the right to seek a second opinion or refuse treatment unless refusing poses a danger to the community or a court of law declares you “mentally incompetent.”
  • Mentally competent adults can choose an alternate treatment or refuse any treatment, even if refusing is likely to cause serious illness or death.
  • A doctor’s treatment recommendations typically balance quality of life with extending life, especially in people with certain health conditions that cannot be cured.

Treatment, as well as certain diagnostic testing, typically requires your informed consent.

Healthcare professionals cannot compel you to receive medical treatment against your will, with a few exceptions.

There are many reasons you may choose to decline the treatment a healthcare professional recommends, including quality of life considerations, cost, and availability of an alternate treatment. You can also delay treatment if applicable.

Keep reading to learn about the patient’s right of refusal and informed consent, the exceptions that may compel you to receive medical treatment without consent, and how to talk with a doctor about declining treatment.

Informed consent is the process by which a healthcare professional explains a medical treatment or procedure before you agree to it. It allows you to make the best possible decision regarding your medical care.

To meet the criteria for informed consent, you must receive and understand:

  • the diagnosis of your health condition
  • the recommended treatment or procedure
  • the risks and benefits of that treatment
  • alternative treatments and their risks and benefits
  • the risks and benefits of refusing a treatment

Medical care follows a shared decision making process. This means healthcare professionals make medical decisions with you rather than for you. You can take as much time as you need to make your decision.

You can ask as many questions as you need to help you better understand the proposed treatment.

Informed consent must take place without coercion, which can include:

  • shouting or yelling
  • omitting information, such as the risks of a health condition or treatment
  • delivering biased information to encourage a particular treatment
  • incentivizing a person to agree to a treatment

Typically, informed consent can be verbal. But in some cases, you may need to provide written consent.

Signing informed consent forms

Some treatments, tests, and medical procedures require informed written consent, which involves signing legal documents stating that you agree to some or all recommended medical care. This may include surgery, bone marrow transplants, or treatments for cancer.

If you don’t understand the forms a healthcare professional asks you to sign, you can ask questions or ask for an additional explanation. If your native language is not English, you can ask for the forms in your native language.

For non-life-threatening health conditions, you may not have to formally decline treatment. Declining treatment and care may also include:

  • not picking up a prescription medication
  • not going to physical therapy prescribed by a doctor
  • stopping use of crutches or a cane early
  • not scheduling a recommended procedure

You can also let your healthcare professional know you do not consent to a particular treatment, test, or procedure.

If you want to decline a treatment or test, it’s best to discuss your reasons with your healthcare professional. They can recommend alternate options and let you know what to expect.

They can also explain their reasoning for recommending a treatment for your particular situation.

Here are some conversation starters to help you discuss your preferences with a healthcare professional:

No treatment

Sample conversation starters about not seeking curative treatment can include:

  • I have weighed the benefits of treatment and the side effects of treatment. I would rather not seek treatment for this condition. What are the possible risks?
  • I have decided I would rather begin palliative or hospice care for this condition than undergo XYZ treatment plan. Do I need to sign any forms to acknowledge my preferences?
  • The side effects of this medication would be intolerable to me. I would rather manage my health condition in another way.
  • I do not want to treat XYZ at this time. I understand and accept the risks of not treating this condition.
  • I prefer not to undergo XYZ procedure or treatment plan. Can you tell me what the next steps would be?

Palliative vs. hospice care

Palliative care and hospice care are two different types of non-curative treatment that focus on improving quality of life. They both focus on improving:

  • comfort
  • emotional support
  • support in making decisions about medical treatment

However, palliative care is available when a diagnosis is provided, while hospice care is only available at the end of life.

Alternate treatment

Sample conversation starters about seeking alternate treatment can include:

  • Is there a less invasive treatment option I could try first?
  • I would prefer to try an alternate treatment first. Is there another way of managing XYZ that you would recommend?
  • I am concerned about the side effects of that treatment. Is there another treatment you could recommend that does not cause XYZ side effect?
  • I have heard about XYZ treatment for my health condition through a television commercial. Would that treatment be a good fit for my individual needs?
  • I would prefer to try an alternate treatment. Is there a clinical trial I could qualify for?

Delay treatment

Sample conversation starters about delaying treatment can include:

  • I do not want to begin treatment until XYZ. Would that delay or cause any long-term risks to my health?
  • I would rather wait to see if I recover from XYZ without treatment. What are some symptoms that would indicate the condition is progressing and that I need medical care?
  • I do not want to treat XYZ condition at this time. But if the symptoms get worse over time, can I change my mind?

Stop treatment

Sample conversation starters about stopping a treatment can include:

  • I would like to stop XYZ treatment due to the side effects to preserve my quality of life. How can I safely stop this treatment? What can I expect after stopping?
  • If I were to stop XYZ treatment, what would my life expectancy be?
  • If I choose to stop all treatment for this condition, what do I need to consider?

Never stop a treatment that you have been prescribed without first talking with the doctor who prescribed it or a member of their team. Some medications can have dangerous, life threatening side effects when stopped abruptly.

Vaccination

Sample conversation starters for expressing concerns about vaccinations can include:

  • I am afraid that this vaccination will cause XYZ side effects. What is the likelihood of that happening, given my health history?
  • I know you recommended the XYZ vaccine based on my age and risk level. I have XYZ concerns about vaccination.
  • I do not want to get the XYZ vaccine. Is there a legal requirement for me to get the XYZ vaccine or booster? Do I require legal documentation of my refusal, and how can I get it?
  • What happens if I get XYZ illness and have not received the vaccine? Can I still get treatment?

After you understand the diagnosis and treatment, it is your right to refuse treatment or choose an alternate treatment if you still want to.

It’s important to note that you may be able to change your mind later.

However, delaying treatment may result in worse outcomes for certain health conditions that require prompt treatment. For instance, it may increase the risk of relapse or make treating it more difficult later on, such as if cancer spreads further in the body or an infection becomes life threatening.

Declining or stopping life-sustaining treatment

Some people may choose to refuse life-sustaining treatment at the end of their lives. This is a legal right under the Patient Self-Determination Act (PDSA) of 1991.

If you choose to decline or stop life-sustaining treatment, such as cancer treatment or dialysis, it’s important to ask questions to understand your life expectancy without treatment.

If you refuse treatment for a health condition that is likely to end your life, a healthcare professional may recommend completing advance directives and estate planning while you can. Advance care planning is typically covered under Medicare.

Estate planning involves preparing legal documents that outline your preferences for financial and medical decisions should you become incapacitated and guide the distribution of your assets after your death. These documents may include:

  • will
  • revocable living trust
  • financial power of attorney
  • beneficiary designations
  • advance directives

Advance directives are legal documents that guide your medical care and outline your preferences for major medical decisions should you become incapacitated. They usually include:

  • a living will
  • durable power of attorney
  • do not resuscitate (DNR) orders
  • physician’s orders for life-sustaining treatment (POLST)

There are a few exceptions to informed consent that may vary by state. These can include:

Mental incompetence

In a medical setting, mental competence refers to the ability of an individual to:

  • understand information relevant to the decision in question
  • weigh risks and benefits and assess alternative options
  • communicate clearly with healthcare professionals about the decision, and articulate their final decision in words
  • demonstrate consistent logic and decision making throughout

Mental incompetence is usually determined by a court.

In emergency situations, healthcare professionals assess competence through a mental status exam. If you are unconscious or in an emergency situation, healthcare professionals can provide treatment.

People who do not have mental competence cannot refuse treatment.

Threat to the community

If a person’s lack of treatment poses a serious threat to the community, treatment may be mandatory. Situations where this may come up can include:

  • treatment for certain communicable diseases that require vaccination or quarantine to prevent spread and support public health; examples may include a diagnosis of Ebola, tuberculosis, or the plague
  • mandatory vaccinations for children, including diphtheria, tetanus, and pertussis (DTaP) and measles, mumps, and rubella (MMR) in certain states
  • mandatory treatment for a person with a mental health condition who is behaving violently and poses a threat to themselves or others
  • court-ordered medical and psychiatric treatment for someone convicted of a crime

Children and minors

A child’s parent or legal guardian cannot refuse life-sustaining treatment for a child or deny their medical care, even on the grounds of religious beliefs.

If a parent or guardian refuses life-sustaining or necessary medical care for a child, they could potentially lose custody of the child and face criminal charges.

In some states, courts may determine that a child protection agency will make medical decisions for the child if four conditions are met:

  • The parents or legal guardian refuse consent.
  • The child would die without treatment.
  • Doctors qualified to treat the child are in agreement about the treatment.
  • The treatment will allow the child to live a relatively typical life with a reasonably good quality of life.

With a few exceptions, you can usually refuse treatment for a medical condition. Your right to do so is protected by informed consent laws.

If you aren’t sure about a treatment, it’s best to talk with your doctor about your concerns and ask about alternate treatments. They can help you weigh the risks and benefits of seeking treatment or not treating a particular health condition.

You can also talk with another healthcare professional to get a second (or third) opinion.