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Temporary and Preparatory Procedures

If the patient refuses only certain types of care, particularly blood transfusions, it should be possible to stabilize the patient's condition for several hours without the use of the forbidden care. A patient who refuses all medical care is more difficult to handle. The health care providers may be forced to render some care against the patient's will just to gain a few hours for the court to make a decision. The goal should be to use the least invasive techniques possible to stabilize the patient. With modern technology, such as "shock suits," it is possible to slow even massive internal bleeding temporarily. These types of techniques, as well as basic lab tests, should be part of the protocol for stabilizing the patient. The medical staff must accept that while these temporary measures are not the best available therapy, they must wait for proper authorization before rendering definitive therapy.

In areas where there are significant numbers of persons who refuse certain medical procedures, there will be physicians who have developed treatment regimes that are acceptable to such persons. An example would be the "bloodless" surgery techniques that some centers have developed. The hospital should keep a list of physicians with these special skills so that they may be contacted.

While the medical staff is stabilizing the patient, the hospital administrator and hospital attorney should arrange for an emergency court hearing to determine if the patient should be treated. The basic legal work (which is peculiar to each state) should be done ahead of time and the necessary forms prepared. The administrator should be able to reach the hospital attorney (or firm) at all times. The attorney should have a list of judges that are available in emergencies. These judges should be contacted ahead of time to determine if they are willing to be contacted at inconvenient times. The administrator should attempt to reach the family or friends of the patient to allow them to testify at the hearing. A psychiatrist, if available, should be brought in to provide testimony on the patient's mental status. These same procedures will be useful in the situation where parent's (or guardians) refuse to consent to medical care for a minor.

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