The Right to Refuse Surgery

A patient may refuse surgery as long as they can understand the decision, the effect that decision will have on them and act in their own best interest.

A competent patient has the right to refuse any treatment, even if it will shorten their life, and choose an option that provides the best quality of life for them. The individual can decide what they believe to be the best quality of life, rather than the medical team deciding for them.

If a patient can grasp the consequences of refusing care, along with the benefits and risks of the treatment suggested by their physician, they have the right to decline some or all surgeries, medications, or therapies.

Why Refusing Treatment May Be Right for You

It is not uncommon for people with chronic or severe illnesses to refuse treatment, even when that decision is going to result in their death or potentially lead to dying sooner than they might if they had surgery.

For example, a patient with chronic heart disease who informs his doctor that he will not have bypass surgery cannot be forced to have surgery, even if his life could be extended by years. A kidney failure patient has the right to choose dialysis and refuse a kidney transplant, even if a transplant will practically cure the condition. Just because surgery is available does not mean it must be done, the patient has the right to determine their healthcare path--including refusing available care.

Leaving a hospital against medical advice (AMA) is one of the most common ways that hospitalized patients use their right to refuse treatment. Television frequently dramatizes a patient sneaking out of the hospital with their gown flapping in the breeze, but the reality is that a patient who insists on going home is required to sign a form before leaving, as long as they are competent and leaving does not pose an immediate threat to their life.

Who Is Not Able to Refuse Treatment?

There are situations where a patient would be unable to make decisions regarding their health. A patient may not be competent mentally to make their own decisions. At that time the patient’s spouse, closest family member or a legally appointed healthcare power of attorney would be responsible for deciding on a plan of care.

Some common situations where a patient would not be permitted to make healthcare decisions include:

• Any patient legally declared mentally incompetent for the purposes of decision making
• An unconscious patient due to anesthesia, trauma, or other causes
• A patient under the influence of mood-altering drugs or alcohol
• A patient who has attempted suicide who is refusing life-saving care
• A patient who has sustained a significant head injury and is not able to understand their current situation
• A patient under the age of 18
• A patient who is unable to understand important information about the planned surgery

An individual can regain the ability to make informed decisions:

• A surgical patient who was under the effects of anesthesia would be able to make their own decisions once they were fully awake after surgery.
• A trauma victim from a car accident could regain the power to make decisions by waking up and being able to understand their situation completely.
• A person who was intoxicated may be able to make their own decisions once they are sober.

When You're Unconscious

When preparing for surgery, a patient can ensure that their wishes will be honored in several ways:

• Have a frank discussion with your spouse or next of kin about your wishes.
• If you do not have a spouse or your spouse/next of kin is not able to make decisions on your behalf, designate a power of attorney. This can be anyone you choose.
• Be clear with your surgeon about your wishes.
• Remember that each situation is different. A patient having a broken leg set may have a very different discussion with their spouse than the same patient a year later who is having brain surgery. Your proxy decision-maker should not be surprised to find out that you chose them to make your decisions—you should have a conversation with that person regarding your wishes and expectations, so they know how to act in your best interest.

A Word From Verywell

Patients should feel empowered to determine what is best for them and to make decisions accordingly. While medical providers are very accustomed to giving their opinions on what is best for the patient, the patient is under no obligation to do what the physician recommends. The advice of the doctor can be taken under advisement, a second opinion can be obtained, or the patient can make the decision that is best for them—even if their decision is to boldly ignore the medical advice they have been given.