How should EMS handle a patient who is competent but refuses treatment?

• A. Document informed refusal, assess decision-making capacity, attempt to contact surrogate if needed, and respect patient autonomy.
• B. Force treatment to ensure life safety
• C. Document refusal but proceed with treatment anyway
• D. Refer to physician after transport

Answer: (A)

Respecting patient autonomy is the key idea. When a patient is competent, they have the right to refuse medical treatment, so the EMS approach is to ensure they truly understand what they’re declining and the consequences.

First, confirm decision-making capacity: can the patient understand the information about their condition and the proposed treatment, appreciate the consequences of accepting or refusing, reason about the options, and communicate a clear choice. If capacity is intact, you document an informed refusal, making clear the information you provided, the risks discussed, and that the patient chose to refuse. You should offer to contact a surrogate or physician for guidance, but you must honor the patient’s decision and autonomy.

If capacity isn’t present, you would pursue appropriate actions under implied consent or involve a surrogate, but that scenario isn’t the focus here. In all cases, thorough documentation and ensuring the patient’s safety are essential.