Community

how and when to refuse surgery

Many aspects of prehospital medicine fall squarely into the category of science. Providers use evidence-based data to make the best choice regarding treatment, or base patient management on established theories in pathology and physiology. These concepts are taught in textbooks and promulgated in peer-reviewed journals. They’re by definition reproducible under similar conditions. Science is the foundation of the practice of prehospital patient care.

However, everyday care is also guided by the art of the profession. This art can’t be taught in a classroom; it’s gained by the sweat of past patient encounters and the collective knowledge passed from provider to provider. These past patient care experiences hone our ability to tell sick from not sick, injured from uninjured, and a safe scene from an unsafe scene. The art of our practice guides patient care when we encounter variables that can’t be accounted for with scientific knowledge alone.

One area of care that’s often challenging is patient refusals. Refusal of care straddles the intersection of ethical, legal and scientific domains of prehospital practice.

There’s great local and regional variability in the laws that govern providers. Consequently, there’s great variation in the patient care guidelines by which they abide. It’s of the utmost importance providers understand these laws and treatment guidelines as they apply to their service area. This article will address the core concepts related to informed decision-making. These concepts should only be applied as they relate to the practitioner’s current local established laws and procedures.