When Emergency Medical Services (EMS) personnel, such as paramedics or Emergency Medical Technicians (EMTs), arrive after a 911 call, a common question arises: can the person legally decline their services or refuse transport to a hospital? The answer balances the medical provider’s duty to care against the individual’s right to self-determination regarding their health. A competent adult generally retains the right to refuse medical intervention, even if EMS staff believe hospital transport is necessary for their well-being. This ability to decline service is a well-established principle in medical ethics and law governing pre-hospital care.
Patient Autonomy and the Right to Refuse Care
The foundational concept allowing a person to refuse an ambulance ride is patient autonomy, which recognizes the individual’s right to make choices about their body and medical treatment. Any competent adult has the right to refuse assessment, treatment, or transport by EMS, even if it goes against the advice of medical professionals. This right is linked to informed consent: if a person has the capacity to consent to care, they also have the right to refuse it. The refusal must be informed, meaning the patient understands their medical situation, the proposed benefits of treatment, and the potential risks of declining care.
The Required Steps for Refusing Transport
For a patient deemed capable of making decisions, refusing transport involves specific steps and detailed documentation. EMS personnel must perform as much of a physical assessment as the patient allows to establish a baseline condition. They must clearly explain the potential consequences of refusing transport, which ensures the refusal is “informed.” This explanation must be communicated in simple language so the patient fully understands the risks of remaining at the scene.
The patient is typically asked to sign a formal legal document, often called a Refusal of Care form or an Against Medical Advice (AMA) release. This form confirms the patient was advised of the risks and is voluntarily declining treatment or transport. If the patient refuses to sign the form, EMS providers will document this refusal and may seek a witness signature from a family member or law enforcement officer. Comprehensive documentation details the patient’s mental status, the risks discussed, and the reason for declining care.
When Refusal Is Not Permitted
There are exceptions where EMS personnel cannot accept a refusal of care, primarily when the patient lacks the medical capacity to make an informed decision. Capacity is a clinical determination made by the EMS provider at the time of the encounter, assessing the person’s immediate ability to understand their situation. This is distinct from legal competence, which is a formal determination made by a court. A patient who cannot understand the information or appreciate the consequences of their refusal is considered to lack capacity.
Conditions Affecting Capacity
Conditions that eliminate decision-making capacity include an altered mental status due to a severe head injury, a diabetic emergency, a stroke, or a significant lack of oxygen (hypoxia). Severe intoxication from drugs or alcohol can also impair judgment to the point where the refusal cannot be accepted. In these situations, the doctrine of implied consent applies, allowing EMS to provide treatment and transport the person to a facility for care. This is because it is presumed the person would want life-saving care if they were able to decide. Furthermore, minors generally cannot refuse care, and EMS must seek consent from a parent, legal guardian, or follow specific state laws regarding emancipated minors.
Understanding the Risks of Refusal
When a person signs a Refusal of Care form, they shift the responsibility for any subsequent health deterioration from the medical system to themselves. The most immediate risk is the potential for the condition to worsen rapidly after the EMS crew leaves, especially if initial symptoms masked a more serious underlying issue. By signing the document, the person acknowledges understanding the potential for serious injury, illness, or death as a result of declining transport.
The signed refusal also serves a legal function, often waiving the patient’s right to pursue legal action against the EMS provider for complications related to the original incident. This means the patient assumes liability for the outcome of their decision. EMS providers advise the patient to immediately seek follow-up care if symptoms change or worsen, and to call 911 again if a new emergency arises.