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When patients refuse beneficial treatment, whether they have decision-making capacity plays a key role in determining the best course of action. However, when patients refuse to explain their reasons, assessment of decision-making capacity can be impossible. How should clinicians respond to such situations? Declining to give reasons for refusing beneficial treatment does not signal the absence of decision-making capacity. However, following the wishes of patients who could be incompetent carries risks. This article argues that, although it cannot be concluded that such patients are incompetent, there are reasons to treat them as if they were. The basis of this possibility, however, points to a number of obligations for clinicians before such a situation can be said to exist.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2004;164(16):1717. doi:10.1001/archinte.164.16.1717
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