Refusal of care: the physician-patient relationship and decisionmaking capacity

Problems of refusal of care, among the most common ethical dilemmas in the emergency department, are also often the most difficult to resolve, pitting 2 conflicting duties, that of helping patients and that of respecting their autonomy, against each other. Using a case presentation as a backdrop, this article offers a practical approach to patients who refuse treatment, including assessment of decisionmaking capacity but emphasizing the role of trust, communication, and compromise in these cases.