The Right to Refuse Treatment
April 11, 2012 2 Comments
Because of my epilepsy, I have had quite a few run-ins with EMS and ER staff in various cities, states, and countries.
It is my policy to refuse treatment if someone calls an ambulance while I’m having a seizure. I have told family, friends, and partners to refrain from calling an ambulance if I have a seizure, unless I’m severely injured.
I’ve had to justify this decision to the vast majority of those I have conveyed my wishes to.
“There’s no point. If I’m not gushing blood, there is no reason for me to go to the hospital. I have epilepsy. I know this. What is the point of getting dragged to the hospital, getting MRIs, EEGs, and a bunch of other tests done–only for them to tell me I have epilepsy? That’s a bunch of debt for nothing.”
Once I lay it out like that, most reasonable people agree. Whether or not they’ll actually abide by my wishes is a different story.
It’s impossible to avoid ambulances, however. I go out, like people do, and Random Dude on the street knows nothing about my medical history or my wishes.
So, I have a seizure. I wake up, EMTs are there. Even in my post-seizure fog, I can tell them that I have epilepsy, and that I’m refusing treatment.
Here’s my problem.
EMTs do not like to be told no.
Medical personnel operate under two doctrines: informed consent, and implied consent. In my situation, medical personnel approach me under implied consent–meaning, that patients who are either unconscious, or “mentally incapacitated” would “reasonably” want to be treated. Patients in an incapacitated state are assumed to have given consent to be treated.
When EMTs first meet me, I’m either unconscious, or in the grey area of being conscious, but incapacitated. Or so they assume.
It’s a very short time after I regain consciousness that I regain my mental faculties. I have epilepsy–I’ve dealt with unconsciousness and seizures many times. I know what that post-seizure state is like. I know how to care for myself, post-seizure. I know what to expect.
I also know what to expect from EMTs. When I regain consciousness, the EMT will be helpful, sympathetic, and will do their best to care for me. The moment I state that I am refusing treatment, it all changes.
The EMT(s) will get hostile and defensive. No, they tell me, I need treatment. I need to come with them. They need to check me out, to run tests. No, I insist. I’m fine. I don’t need treatment. Next, they belittle me. I don’t know what I’m talking about. I don’t know what’s best for me. I could have severe injuries. I couldn’t possibly know if I’m injured or not. I need to come with them.
I persist, however, and eventually they relent. They make it very clear they disapprove, and act accordingly every step of the way.
This is how it has always gone.
Until last week.
Last week, I had a car accident. My epilepsy was not the cause. I did a quick self-evaluation at the scene, and I determined that I didn’t have any injuries to worry about—certainly nothing to merit the large bills that a hospital trip would result in. I told the responding officers that I didn’t need an ambulance. They disagreed. When the EMTs arrived, I answered their questions, and told them that I would be refusing treatment.
Not only did they get hostile and defensive, but they refused to accept my refusal. “You have no choice,” they told me, “You’re coming with us whether you want to or not. The only choice you have is what hospital we take you to.”
Hmm. Not mentally capable of choosing to refuse treatment, but capable enough to decide which hospital to go to. Interesting. Okay, then.
“Well, I’m not going to any religious hospital, I can tell you that right now.”
The EMT was taken aback. Once he recovered, he listed my remaining options. I chose the hospital my physician is affiliated with.
I’m rather forceful and opinionated for someone incapable of making my own medical decisions, aren’t I? I hope the EMT received the message sent in my glare.
Interestingly enough, I did not receive the treatment the EMTs insisted I needed. I wasn’t immobilized, like car accident victims are supposed to be. I wasn’t given an IV, like seizure victims usually are. They took my blood pressure and my heart rate. That was it.
It wasn’t about getting me medical treatment they thought I needed. This was a power play. As a patient, I was supposed to acquiesce. I was supposed to submit to their judgment. When I didn’t, they took it as a challenge to their authority–and they abused that authority.