Practical aspects of the issue of patients refusing medical care

The issue of patients refusing medical care is one of the most difficult and complicated in the medicolegal world, and involves moral and philosophical questions in addition to medical and legal ones. Article 13 (A) of the Israeli Patient Rights Law of 1996 (hereinafter: "the Patient Rights Law") emphasizes the autonomy of the patient over his body and explicitly states that "No medical care will be given to a patient unless informed consent is given by him..." Article 13 (B) (4) of the Patient Rights Law states that obtaining informed consent requires the caregiver to give the patient the medical information required to a reasonable extent to allow the patient to decide whether to agree to the proposed care, including information on the odds and risks of alternate medical treatments. It is important to clarify, however, that the patient's right to give or withhold informed consent to medical care, does not grant him under any circumstances a right to dictate to the caregiver to use medical methods that are unconventional or that are not medically indicated, thus violating the known edict: primum non nocere (first, do no harm). This paper provides some case studies and discussion of illustrative situations.