In some cases, disagreement arises over the choice of treatment. If the physician believes the patient is making a poor choice because of a lack of knowledge or information, the physician must inform the patient more fully. A competent patient can always abandon medical care, but a physician cannot abandon a patient. A competent patient’s choice will almost invariably be upheld in court.
Nevertheless, a physician is not required to honor a patient’s treatment choice if the physician strongly disagrees with it, even if the patient is competent. If such issues cannot be resolved, the physician can withdraw from the case after examining the risks and benefits of each treatment option, the patient’s right to self-determination, and the physician’s own commitment to current practice standards and professional integrity. If the physician decides to withdraw, the patient should be notified, perhaps by certified mail. Care should be terminated only upon referral to another physician or after giving the patient ample opportunity to find another physician.
When a patient lacks capacity to make medical decisions or has been declared incompetent by a court, a surrogate decision maker is usually needed. A surrogate is the person who should best know the wishes of the patient and thus is able to speak for the patient. The surrogate may be the next of kin, someone granted durable power of attorney for health care decisions by the patient, or someone appointed by the court. Ch. 108 discusses surrogate decision makers