Legal Eagle Eye Newsletter for the Nursing Profession (7)7 Jul 99

Quick Summary: A competent patient can refuse treatment, even life-saving treatment caregivers genuinely believe the patient should be given.

   In an emergency a patient who refuses treatment can be treated anyway, even going against the patient’s wishes.

   However, in this context a medical emergency exists only when the patient lacks the mental competence to make an informed decision.  SUPREME JUDICIAL COURT OF MASSACHUSETTS, 1999.

   A young adult patient came to the hospital emergency room having an acute asthma attack. She had been asthmatic since her youth.

   A nurse began to monitor her situation. When her blood gases came back the nurse decided the oxygen mask was not sufficient and convinced the physician to try to intubate her.

  The patient and her older sister both voiced adamant disapproval of the plan to intubate her and they both ran from the emergency room. They were chased through the hospital’s corridors by hospital security guards. The patient was caught, returned to the emergency room, strapped down in four-point restraints and forcibly intubated. The patient recovered from the asthma attack and was discharged.

   Two years later she died after refusing to go to a hospital for an asthma attack. The family filed a lawsuit alleging her death was attributable to fear of hospitals, doctors and nurses from the trauma of the forced-intubation incident. The Supreme Judicial Court of Massachusetts upheld the family’s right to sue for wrongful death.

   The court noted that a medical emergency justifies non-consensual treatment only when it is not possible or feasible to obtain informed consent from a person legally entitled to provide or withhold consent. Even in a life-threatening situation, a care provider cannot substitute his or her own judgment for that of a mentally competent adult patient or family member. Shine v. Vega, 709 N.E. 2d 58 (Mass., 1999).