Question: I always tell my staff and students not leave a person who feels ill unattended. But what if an outpatient says he/she feels sick and wants to go lie down, but refuses to accept any assistance? Do patients have a right of refusal of assistance? What happens if they refuse to wait, to accept help, or to leave before they are released? If they faint and have an injury, who's liable? I have tried a search but can't find any articles that specifically address that situation.

Our response: Patients certainly have the right to refuse assistance. That does not mean they are withdrawing consent for the procedure, but it does create a predicament because the patient has submitted him/herself to your care, only to then refuse an aspect of it.

Let's look at it this way. If a patient with a history of passing out refuses to be recumbent, drawing them upright violates the standards. You have the right (and an obligation) to refuse to draw the patient if he/she can't be persuaded.

Now, let's say a patient is already feeling faint, but refuses assistance to be relocated to a recumbent position, which is at the core of your question. In our opinion, we think you still have to provide it. Since the patient is in your care, and they submitted themselves to your care by presenting for a blood draw, failure to provide it would be hard to defend in a legal context. If you honor the request and the patient faints, your facility could be sued for performing beneath the standard of care. On the other hand, if you provided it against the patient's wishes, the patient could become irate. Neither outcome is pretty, but I'd prefer the irate patient than the lawsuit.

It's a sticky wicket, and one that should be discussed with your risk manager and/or legal counsel. A policy should be established with their input and the staff made aware of it.