Patient Refusal and Capacity Assessment

Patient Refusal and Capacity Assessment at the AEMT Level

1. The Four Ways a Patient Can Be Treated Legally

Every call starts with consent. We'll start there.

There are four kinds, and the exam wants you to know which one is active on a given patient.

• Expressed consent. The patient says yes, out loud or in writing. For it to count, the patient has to be an adult with decision-making capacity. You have to have told them what the care is, what the risks are, and what the alternatives are.
• Implied consent. The law assumes a reasonable person would say yes if they were unresponsive and facing a threat to life or limb. You're not asking the patient. You can't. The law is answering for them.
• Involuntary consent. Some legal authority is authorizing care instead of the patient. A law enforcement hold, a court order, a mental-health hold. The patient is not the one consenting here.
• Informed refusal. The patient says no. For that no to be valid, you have to have told them what you suspect, what could happen if they refuse, and what their other options are. They have to show you they understood it.

Implied consent has one rule you cannot miss on the exam. It ends the moment the patient regains capacity and objects. You don't get to keep treating someone under implied consent once they wake up and say stop. At that point you're back to needing expressed consent, or you're dealing with a refusal.