[Refusal of medical treatment in an acute comatose patient]

The Dutch Law on Medical Services ('Wet Geneeskundige Behandelingsovereenkomst') of 1995 declares that doctors must adhere to an Informed Refusal (a written Refusal of Medical Treatment) if the patient is unable to give informed consent on presentation at hospital.

A comatose 81-year-old man was presented at the resuscitation area following attempted suicide with insulin. Treatment was suspended after the family presented the doctor with an Informed Refusal that had been signed by the patient. The question was to what extent this statement of intention or the family's wishes could prevail over the medical insight of the doctor. During subsequent discussion it became apparent that opinions vary greatly between doctors on this subject.

Patients and doctors have little knowledge of negative statements of intention. The doctor can help the patient in formulating a realistic statement of intention, and document the patient's wishes in the patient's written or electronic medical dossier. A representative designated in writing can help to interpret the declaration of intention.