When a Patient Refuses Life-Sustaining Treatments

The consensus view on the ethics of life-sustaining treatments, as opposed to medical paternalism, implies that patients have the right to refuse any treatment, even if it is necessary for survival. For patients, however, the right to refuse is not always self-evident. Apart from religious reasons, a decision to accept or to refuse a life-sustaining treatment is also part of understanding and redefining responsibilities generated in relationships with others for whom they care. Different types of reasons can lead patients to refuse life-prolonging treatment. These reasons include: 1. Disadvantageous costs-benefit ratio, 2. futility of a treatment, 3. lack of meaning of the life saved, 4. a pre-existing with to die, 5. acceptance of life’s ending, and 6. the desire to regain agency. On this basis, I try to explain the patient’s right to refuse in a more nuanced way: Moral considerations that may outweigh the option of refusing for the patient do not override the claim of patients that the others must respect their right to make the final decision. The key clinical-ethical questions are therefore not about rights to refuse life-sustaining treatments alone but about the conditions that give the patient sufficient strength to endure and to accept a life-sustaining treatment, which may appear meaningful from a medical point of view.