Monday, March 26, 2012

Author Question: Refusing Medical Treatment

Carrie Asks:

My novel is set in the US and my MC, who's eighteen, is injured. He's suffering from concussion, blood loss, and hypothermia, and is very weak and quite disorientated. He is, however, conscious and responding, and adamant that he does not want to be treated or taken to a hospital (and the plot requires him not to be). I understand that he'd be able to refuse treatment if he signed a form saying so. My question is, is there a standard procedure that an EMT would follow before letting him sign?

Jordyn Says: Thanks for e-mailing me your question. You have an interesting scenario here.

I'm going to come from the standpoint of this person presenting to the ER. Put simply, we are not going to let this patient sign out AMA. A couple of things in your statement about his condition will prevent this. Almost everything you've listed as far as his medical condition makes it impossible for him to make a reasonable decision regarding his care--concussion, disorientation, hypothermia. Even though he can talk, it doesn't mean he has enough medical capacity to make an appropriate decision regarding his care until these issues are straightened out.

We would do everything in our power to keep him in the ED. Considering that-- you have a couple of options. Make him a lot less sick. Maybe just a few bumps and scrapes. Or, he could elope from the ED somehow, but if we were really concerned about his medical condition we might send the police to fetch him back. Of course, this could add conflict into your story.
I did verify this through an EMS friend of mine as well. The issue is not whether or not they can talk, it's whether or not they are medically competent to make a decision about refusing care. This character's condition precludes that.


  1. Great question!
    I totally agree with Jordyn. If this patient is truly concussed and "disoriented" then he can't really be deemed mentally competent enough to sign himself out. Perhaps if the patient were 17 versus 18 and an extremely competent-appearing guardian (or someone pretending to be his guardian...) signed him out? ED/EMS experts, would that help?

    Alternatively--I agree that you could try making him a lot less sick looking. There are a few situations where you could really *look* okay and end up not being okay after a few hours.

  2. Thanks for the help. I managed to get him out of the hospital, though not out of the woods. Not giving any more spoilers than that.

  3. Carrie, as someone who has been hypothermic several times, I would ask you resolve this condition before you have your character do much more than sit and blubber. Even a mild case leaves me disoriented and barely able to walk. The major case I had left me totally in the hands of people who saved my life. A mild case feels very similar to a serious sugar drop--slurred speech, inability to stop shaking, interferes with walking straight, or making decisions. When my first major attack happened, I was 30 feet underwater, and I had to be hauled out. My dive gear kept me from drowning. I shivered for a long time, and didn't totally pull out of it for several hours. It is a terrifying thing to happen, in part because your brain stops functioning in the way you know it should.

    Jordynn, if anyone wants to know what this feels like, feel free to send them my way.

  4. Thanks for your comment, Amitha! Ramona...I'd love to have you guest post if you'd like about your hypothermia and what it was like.