But given that he didn't--for reasons that in hindsight are fairly easy to understand and have as much to do with the physician and the system as with the patient--the physician must honor his competent, informed refusal
Document any discussion you have about informed consent and informed refusal
Documentation is not technically an element of informed refusal, but risk management professionals believe that physicians should make a notation of such a conversation in the medical record at the time the patient states she refuses the procedure.
The issue of informed refusal was used in a 1996 trial, about 20 years after the doctrine was first recognized in California.
To advocate informed consent without informed refusal is, on this view, to entirely gut the former of all significance.
Given the widespread endorsement of Mill's strong antipaternalism, an individual's informed refusal of lifesaving medical care is presumably beyond the purview of the liberal state and its courts and committees.
This supposition is supported by the unusual practice, in California, of requring that patients not only sign a consent form when accepting testing but an informed refusal
form if they reject testing.
4] Since, under hypothetical circumstances, neither the benefits nor the risks of treatment can be properly weighed, any statements Nancy made prior to her automobile accident regarding life-sustaining treatment did not constitute informed refusal
Conscientious objectors have noted that informed refusals
, already carrying force in law, have in the past been overthrown on the grounds that refusal was made without adequate information, or that the conditions were not completely relevant, or that refusal was itself suggestive of incompetence--all circumstances where others' views of the best interest of patients rather than their self-determination become controlling.