An adult who refuses emergency medical care poses a difficult problem. Society does not give parents the right to kill a child through neglect, but it does allow an adult to commit suicide by refusing lifesaving medical care. The only conditions are that the adult must demonstrate that he or she is mentally sound and that the care is being refused for a proper reason, such as a religious objection to care or the presence of a terminal illness. These two conditions often merge. If the court finds the reason for refusing care frivolous, this will be taken as evidence of an unsound mind.

As with a child, the patient should be evaluated to determine the needed care and the consequences of not providing that care. A judge should be contacted at once. If the patient remains conscious, the grounds for the refusal of care should be explored and carefully documented. A full mental status examination should be documented in the chart. A psychiatric consult can document the patient’s fitness to make reasoned decisions. The attending physician should prepare a care plan that attempts to intrude as little as possible on the patient’s beliefs, while still preventing permanent harm. Such a specific, limited- care plan will encourage the judge to allow the patient to be treated until the case can be reviewed in a formal hearing.