What do you do with a patient who does not want medical care? On the one hand, he/she (as long as he is older than 18) is in control of his body. He can sign out "AMA" (against medical advice), which means that you covered your legal grounds by telling him what you suggest as a doctor, but he declines following that advice. Jehovah's witnesses are free to refuse blood and blood products, and then you do the best you can with things they might accept like saline or erythropoietin (EPO). In these situations, the patient decides what kind of care he would like.
But on the other hand, a physician can detain a person seriously contemplating suicide. We won't let him kill himself. He does not have control over his body. And if we aren't sure whether someone wants medical care, we treat him as aggressively as possible, assuming that's what's in his best interests.
Clearly, this post brings up many emotion-laden and difficult issues. Are there cases when not-treating is better than treating? How do we approach those cases? Where are demarcations to be drawn?
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