Refusal of Care by Patients

To the Editor: In the Grand Rounds discussion of a patient's refusal of care, Dr Carrese¹ describes a familiar and difficult case in which respect for patient autonomy conflicts with the principle of beneficence: an older bedbound woman, judged competent to make medical decisions, refuses nursing home care after a hospitalization, yet the medical team is concerned that she cannot receive sufficient care at home to prevent further deterioration.