Physicians' non-compliance with patients' refusal of life-sustaining treatment

Should patients be treated when they have specifically refused treatment? Three competent patients are described with end-stage renal disease who, against the advice of their family, friends and care-givers, refused dialysis. Each was treated and subsequently they acknowledged their satisfaction with the outcome. Guidelines for treating patients when consent is refused are discussed and it is suggested that this is permissible in life-saving situations where the patients' refusal is idiosyncratic and irrational.