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Editorials |

Enigmatic Refusals : The Difference Between a Potential Problem and One in a Patient Under Our Care

A. Joseph Layon, MD, FCCP; Cory Franklin, MD
Author and Funding Information

Affiliations: Gainesville, FL
 ,  Dr. Layon is Professor of Anesthesiology, Surgery, and Medicine, Chief, Division of Critical Care Medicine, University of Florida College of Medicine, and Medical Director, Gainesville Fire Rescue Service.,  Chicago, IL
 ,  Dr. Franklin is Professor of Medicine, Director, Medical Intensive Care Unit, Chicago Medical School.

Correspondence to: A. Joseph Layon, MD, FCCP, Department of Anesthesiology, 1600 SW Archer Rd, POB 100254, JHMHC, Gainesville, FL 32610-0254; e-mail: layon@ufl.edu



Chest. 2004;126(2):337-339. doi:10.1378/chest.126.2.337
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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 extent14 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?

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