Dr. Joseph Sirven: Sometimes You Can't Refuse Treatment
I was supervising a free neurology clinic the other night and a teenage patient started to have a full-blown convulsive seizure right after I introduced myself.
He recovered briefly, but then the seizures repeated themselves over and over and over. Chairs were flung, the room was cleared, staff appeared and we were in the throes of a medical emergency in a setting with minimal resources.
My trainee, nurses and myself attempted to manage the situation without the availability of IV medications necessary to stop the seizures. I knew that he needed urgent medical attention in a hospital.
Complicating matters, the patient only spoke an African dialect, and it is unclear how much he understood what I was saying. His mother pleaded with me, "Please do not call 911, please."
I said, "But this is lifesaving. We have tried everything we can with what we have."
She yelled in broken English, "The ER will bankrupt us! Please, please."
I looked at the patient, and he gave me a long pleading look for help. At the end, I called 911 his mother cursing me.
My medical training has prepared me to help those in need. But what do you do when someone refuses treatment? Can they?
Although patients by law have the right to make decisions regarding their own health, there are exceptions to the right to refuse medical care.
In instances of an emergency, informed consent can be bypassed if immediate treatment is necessary for the patient’s life regardless of whether the patient and their family agree with the plan.
Situations where this may occur include when someone has an altered mental status from any cause. Children cannot be denied life-sustaining treatment, nor can their parents or guardians deny medical help to a child even if their religious beliefs discourage medical treatment.
There are limited statistics in terms of the percent of people who actually refuse a treatment out of fear of the cost of the therapy. However, we know from patient surveys that the most commonly cited reason for refusing treatment is financial followed by religious beliefs.
A week after this emergency, my only memory of the patient is his eyes. It spoke a universal language that said "help!"
A few days later, I received a phone call from the admitting doctor, and I found out what had caused all those seizures to begin with. The kid had an infected tooth triggering his repetitive seizures.
I'm happy I made that call.
Dr. Sirven is a neurologist at the Mayo Clinic.