Elder Law Estate Planning Legal Topics

Do Patients Have the Right to Refuse Treatment?

Short answer, yes. Competent adults have the right to refuse medical treatment. But that doesn’t mean that the state can’t get involved.

In Thor v Superior Court (1993) 5 C4th 725, the first right-to-die case heard by the California Supreme Court, the court ruled that mentally competent adults have a “fundamental right” to refuse life-saving assistance.

In that case, Howard Andrews jumped or fell from a wall while serving a life term in prison. His injuries rendered him a quadriplegic, requiring medical personnel to assist him with all bodily functions. Andrews refused to be fed from time to time and refused necessary medication and treatment for his general care. As a result, he was at risk of death because of possible pulmonary emboli, malnutrition, infection, and renal failure. Staff psychiatrists, however, found him competent to understand his circumstances, even though he was depressed.

His attending physician, Dr. Daniel Thor, sought an ex parte order in superior court that would allow him to use certain medical procedures to feed and medicate Andrews against his will. The supreme court denied the physician’s petition for a writ of mandate, writing that

After due deliberation, we hold that under California law a competent, informed adult has a fundamental right of self-determination to refuse or demand the withdrawal of medical treatment of any form, irrespective of the personal consequences.

The state argued that Andrews wasn’t suffering chronic pain or enduring “unending agony” like the patients in previous right-to-die cases. The court wasn’t swayed;  instead, it noted that “for self-determination to have any meaning, it cannot be subject to the scrutiny of anyone else’s conscience or sensibilities. It is the individual who must live or die with the course of treatment chosen or rejected, not the state.” 5 C4th at 741. The court also stated, “Particularly when the restoration of normal health and vitality is impossible, only the person whose moment-to-moment existence lies in the balance can resolve the difficult and uniquely subjective questions involved.” 5 C4th at 728.

But the court carefully recognized that the right to refuse medical treatment isn’t absolute. Four state interests must be considered in determining the scope of the patient’s autonomy:

  1. preserving life
  2. preventing suicide
  3. maintaining the integrity of the medical profession
  4. protecting innocent third parties

In Thor, the court addressed each of these interests but found that either the interest didn’t override the individual’s right of self-determination and bodily integrity or it wasn’t a concern in that case.

This means that in most situations, competent adults may choose their own destiny and refuse medical intervention. But there may be a fact situation in which the state’s interests may override that choice.

Get expert guidance on the legal and medical issues involved with health care decisions in CEB’s California Powers of Attorney and Health Care Directives, chap 9.

Other CEBblog™ posts you may find helpful:

© The Regents of the University of California, 2018. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited.

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