In this issue of CHEST (see page 630), Bramstedt and Arroliga present the cases of two patients who refused therapy for reasons that were considered to be “enigmatic.” That is, a “refusal of therapy without any reason given by the patient.” These cases are not unique inasmuch as many of us have cared for such patients. However, the authors raise several important points that require some discussion and, perhaps, debate.
We think that the authors are addressing an important issue that has been discussed to a limited extent1–4 in the medical literature. Does the rejection of therapy by a patient require the physician to honor that rejection when doing so would mandate the provision of substandard care? Are all refusals of therapy to be honored? Does the knowledge (power) of the physician ever trump the patient’s right to refuse therapy?