What should you keep in mind when treating a patient that refuses medical care?

• A. The state's interest always overrides patient autonomy
• B. The patient's wishes can be overridden if necessary
• C. The right to refuse treatment outweighs the state's interest
• D. The duty to respect competently expressed views of the patient, even if it amounts to death.

Answer: (D)

Respect for a competent patient’s autonomy means honoring their informed refusal of treatment, even if that decision could lead to death. If a patient clearly expresses they do not want care and they have decision-making capacity, a physician should provide all relevant information (risks, benefits, alternatives), confirm the patient understands it, and respect their decision. Document the discussion and the capacity assessment.

State interests or paternalism do not automatically override a competent patient’s refusal; exceptions apply only when the patient lacks capacity or in certain emergencies where there isn’t time to assess decision-making ability or obtain surrogate consent. If the patient is not competent, involve a legally authorized surrogate or follow applicable advance directives.