Patient’s refusal of emergency care and the right to self-determination: A case report and related ethical and legal aspects

Background: Consent and refusal of care are pivotal issues in clinical practice, underscored by the legal protection of self-determination. Obtaining informed consent is a rigorous process requiring clear communication to enable patients’ autonomous decisions. When a patient with legal capacity refuses care, clinicians have a legal and ethical duty to assess decision-making capacity, verify understanding of the risks and benefits, communicate the consequences of refusal and propose appropriate alternative interventions, respecting the patient’s will. In emergency situations, this process is further complicated by time pressures and other patient related factors. Methods: We report a case involving a legally competent patient with bowel ischemia who refused emergency surgical intervention, described in accordance with the CARE guidelines. The case was identified during routine clinical practice and selected due to its ethical and legal relevance in the context of treatment refusal in emergency care. Clinical data were retrospectively collected from medical records, including clinical notes, diagnostic findings, and documentation related to informed consent and refusal. The patient’s decision-making capacity was clinically assessed and documented by the treating physicians. The information provided to the patient regarding diagnosis, prognosis, risks, benefits, and available treatment alternatives was documented. The case was analyzed from a medico-legal perspective by comparing clinical management with current ethical principles on informed consent and refusal of treatment. Conclusion: The fundamental right of patient self-determination, exercised through consent or refusal, must be respected in all clinical settings, and healthcare practitioners are obliged to provide adequate information to support informed decision-making. Meticulous documentation of the entire decision-making process is essential to safeguard both patient rights and clinicians’ legal responsibilities.