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A University of Alabama Law School Clinical Program funded in part by West Alabama Regional Commission

Advance Health Care Decisions

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1(a). Right to consent to/refuse treatment

A patient’s right to consent to or refuse medical treatment has been well established for decades. A competent patient has the right to be fully informed about what treatments are available and the benefits and burdens of each. The patient has the final decision about accepting or rejecting treatment, even against medical advice.

In the early 1900s, most people died suddenly, and death usually occurred at home. As medical treatment advanced in the 1900s, however, more and more often death came at the end of lingering or chronic illness or disease. By mid-century most deaths occurred in institutions. Artificial life-sustaining treatments began to be used routinely on patients who were no longer able to state their wishes.

As the century progressed, many people became aware that treatments which could result in miracles in cases where there was hope, could also result in grotesquely prolonged and undignified deaths when used in hopeless situations. Medical providers who recognized the futility of heroic measures in some cases were caught in situations in which patients were unable to make or communicate decisions and family members were divided or ill-informed.

People began to demand ways to state in advance their desire not to receive futile and unwanted treatment if they became unable to speak for themselves. Gradually the idea of making choices in advance gained acceptance.

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