Approach to treatment refusal

Determine legal decision-maker
- Self: legal/competent adult or emancipated minor
- Surrogate decision-maker: parent/guardian, specified proxy, default surrogate (eg, spouse, adult child)
Counsel decision-maker
- Assess level of understanding, health literacy
- Explain natural history of disease, pros & cons of treatment options
Continued refusal
- For life-sustaining treatment:
  - Engage care team, social services
  - Consult facility ethics committee
  - Initiate legal action for court order
- If immediate care is needed (eg, life- or limb-threatening condition):
  - Provider should administer care over surrogate refusal