The Bartling Case

Abstract

The recent legal decision in the Bartling case affirmed that competent patients may refuse life-sustaining treatment, even if they are not terminal or comatose and even if physicians object because of ethics or conscience. However, clinicians may be concerned that patient refusal of treatment is not truly informed. Physicians have an obligation to benefit patients as well as to respect patients' wishes. They may fulfill both obligations by determining whether further medical treatment is indicated, identifying reversible conditions that may impair patient decision making, and checking that the patient's decision is informed.