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February 1992

Shepherding the Patient's Right to Self-determination: The Physician's Dawning Role

Author Affiliations

Department of Medicine Harvard Medical School Boston, Mass

Arch Intern Med. 1992;152(2):259-261. doi:10.1001/archinte.1992.00400140013003

The right of a competent patient to accept or refuse treatment has been anchored in the common law for many generations in this country. Based on this right, the competent individual may refuse any procedure or treatment, be it pulmonary resuscitation, invasive diagnostic testing, or any life-prolonging treatment, even if the outcome is almost surely fatal. Such is not the case for incompetent patients. In the absence of credible evidence to the contrary, health care providers must assume that the competent patient would consent to reasonable therapy to prolong life and physicians and hospitals are usually obliged to institute life-prolonging care that represents a reasonable therapeutic option unless they have been instructed by the patient not to do so. In effect, the incompetent patient may be denied the right to refuse therapy that the competent patient may refuse. The American courts, however, have recognized that this right that is guaranteed

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