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COMPLYING WITH A PATIENT'S REFUSAL OF CARE

The American legal system is based on achieving politically acceptable rules within the limits posed by the Constitution. The courts are loath to interfere in the medical care decisions of competent adults, a product of the high value placed on patient autonomy. It also reflects judicial economy. Unlike attorneys, judges prefer to minimize the number and types of disputes that must be judicially resolved. The courts will upset the decision of a competent patient only when other stakeholders present a compelling argument for overriding the patient's interests.

Once patients have indicated their desires in a living will or by a surrogate decision maker appointed by a power of attorney, physicians should heed these instructions. Unnecessarily delaying the termination of life support, or forcing unwanted life support while contesting the patient's decisions in court is legally risky. On its face, this assertion seems too simplistic. It appears to ignore the raging debate among ethicists over the proper role of physicians in termination of life-support decisions. On closer analysis, however, it is clear that following the patient's wishes is both ethically correct and legally safe.

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