Can We Refuse Treatment?

Caregivers and patients need to talk about which life-sustaining treatments are wanted - and which are not. Your wishes can be documented as part of an advance care plan. Among the most difficult decisions are those surrounding treatments such as artificial nutrition ("tube feeding"), intravenous (IV) hydration, antibiotics, and ventilators (breathing machines). These treatments are usually put in place because there is some hope that a patient is going to recover from a temporary setback. Deciding to use these treatments in the course of a serious, chronic illness demands careful consideration. Once treatments have begun, it can be hard to decide to stop. You and your loved one need to know that treatment can be stopped whenever you decide to do so.

When making any medical decision, weigh the benefits and burdens. Artificial treatments are often very effective. Many people are alive today because of such treatments. Indeed, when there is any doubt about whether a treatment will improve comfort or quality of life, a "time-limited trial" is often very useful. The key is to define the time limit before starting the treatment, so that everyone realizes that it will be reassessed. The burdens of a treatment should not be ignored just because it is keeping someone alive. If a treatment is not improving the patient's life or prospects, it should be stopped.