The hospital should have a written policy on dealing with adult patients who refuse some or all medical care. This policy must deal with the problem of keeping a patient alive until a court order can be obtained authorizing treatment. The hospital must decide beforehand it will render lifesaving care while a court order is sought. The hospital's decision must take into account the practical difficulty of preventing the emergency room personnel from trying to save the patient's life. The physicians involved will tend to assume (not unreasonably) that a person who refuses lifesaving care must be so affected by the illness or injury that the person is not acting rationally. The degree of competency of a severely ill or injured patient is sufficiently difficult to determine that it may be unreasonable to let the patient die, based on a refusal of care, without further investigation of the circumstances surrounding the refusal of care.
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