On the dilemma of enigmatic refusal of life-saving therapy

Katrina A. Bramstedt*, Alejandro C. Arroliga

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

8 Citations (Scopus)


When patients give no reason for refusing therapy (an enigmatic refusal), this creates the dilemma of whether or not to administer the therapy by force, especially when the therapy poses low risk and offers significant benefit. We argue that there is a duty to assess the patient's decision-making capacity, as well as attempt to understand a patient's reason(s) for refusing treatment. While some patients may not readily offer reasons for refusing treatment, this does not preclude an obligation for clinicians to inquire about such. The reasons for treatment refusal can be related to the patient's goals, values, fears, and mental state.

Original languageEnglish
Pages (from-to)630-633
Number of pages4
Issue number2
Publication statusPublished - Aug 2004
Externally publishedYes


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