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Refusing Medical Treatment

The right of a competent adult to refuse any treatment, including one that keeps them alive; what happens when the patient cannot decide; and the limits the law places on it.

Informational only - this is not legal advice. These definitions explain general legal vocabulary in plain English. They are not advice about your situation, reading them creates no attorney-client relationship, and the law differs from state to state and changes over time. For advice you can rely on, speak to a lawyer licensed in your state.

What it means

A competent adult may refuse any medical treatment for any reason or none, including treatment without which they will die. That is the foundation of informed consent stated the other way round: treating a person without consent is a battery, and the Supreme Court has assumed that the Constitution protects a competent person's right to refuse unwanted medical treatment, including artificial nutrition and hydration. Religious refusals, refusals of blood, and refusals that doctors consider irrational are all within the right, provided the patient has the capacity to understand the decision and its consequences.

Capacity is the hinge. A patient who lacks it cannot exercise the right directly, and the question becomes who decides for them and on what evidence. A valid advance directive or a health care agent under a medical power of attorney speaks for the patient; failing those, state law names default surrogates and sets the standard they must apply. A state may require clear and convincing evidence of what an incapacitated patient would have wanted before life-sustaining treatment is withdrawn on a family member's say-so, and the Supreme Court has upheld that requirement. Capacity is decision-specific: a person may be able to decide about one treatment and not another, and a psychiatric diagnosis does not by itself remove it.

The limits are few but real. A parent's refusal of treatment for a child can be overridden by a court where the child's life or health is seriously at risk. A refusal in an emergency by a patient who cannot communicate is presumed not to exist, and treatment proceeds. Civil commitment and court-ordered treatment statutes allow involuntary treatment in defined circumstances, and prisons may treat under a narrower standard. And the right to refuse treatment is not a right to demand it: the Court has held there is no constitutional right to physician assistance in dying, leaving that to the states, a minority of which permit it by statute under conditions those statutes set.

Where this comes from

Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 (1990) (assumed constitutional right of a competent person to refuse treatment; a state may require clear and convincing evidence of an incompetent patient's wishes); Washington v. Glucksberg, 521 U.S. 702 (1997) (no constitutional right to assisted suicide); Schloendorff v. Society of New York Hospital, 105 N.E. 92 (N.Y. 1914) (treatment without consent as a wrong). Advance directives, surrogate decision-making and capacity are state law, largely modelled on the Uniform Health-Care Decisions Act. Medical aid in dying is permitted by statute in a minority of states, beginning with the Oregon Death with Dignity Act, Oregon Revised Statutes § 127.800 and following.

When people hire a lawyer for this

A person who wants their refusal honoured if they lose capacity should execute an advance directive and name a health care agent now, in the form their state recognises - that document is what prevents the dispute, and a lawyer or a hospital's patient advocate can help complete it. A family facing a hospital that will not honour a refusal, or a hospital facing a family that disputes one, should get advice quickly; ethics committees resolve most such disagreements and courts the rest, and both work faster with the patient's wishes documented.

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Part of the LawyerLand plain-English legal glossary. Definitions are written from primary sources - statutes and court rules - and each entry states the authority it rests on, or says plainly when the doctrine is state law with no national rule.

If you cannot afford a lawyer, civil legal aid programmes provide free help with many of these problems: civil legal aid programmes by state.

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