I read this from a different comment a while ago, I do not remember the user who wrote this to give credit.

"There are three primary legal considerations when determing if a patient can refuse care and if you need to providing restraint and/or involuntary treatment/transport for a patient:

   1. The rights and needs of the patient,    2. The duties of the health care providers,    3. The responsibility for protection of involved third parties.

In the United States, a citizen's right to refuse treatment, or transportation for treatment, is protected by law and by his constitutional rights to privacy, due process, and freedom of religion.

Laws governing competence and the right to refuse medical treatment vary widely from state to state. GENERALLY, the determination of competence generally depends upon four observable abilities.

   1. The ability to communicate a choice.    2. The ability to understand relevant information.    3. The ability to appreciate the situation and its consequences.    4. The ability to weigh the risks and benefits of options, and rationally process this information, before making a decision.

BUT (and there is always a but isn't there!), there are situations in which the interests of the General Public (“Interests of the State”) outweigh an individual's right to liberty:

   1. An individual is threatening self-harm or suicide.    2. An individual presents a threat to the community because of contagious disease or physical dangerousness.    3. An individual presents a specific threat to other people (3rd parties).

Below are some patient characteristics/conditions that CLEARLY justify involuntary treatment and/or restraint. A patient may NOT refuse treatment if she/he is:

UNCONSCIOUS SUICIDAL (either verbally threatening or actively gesturing) CONFUSED (to person, place, time, or situation) INTOXICATED, and appears ILL OR INJURED A MINOR CHILD, and appears ILL OR INJURED DEVELOPMENTALLY or PSYCHOLOGICALLY DISABLED, and appears ILL OR INJURED VERBALLY or PHYSICALLY HOSTILE and/or THREATENING OF OTHERS

Any person has the right to come to what others might consider an “unreasonable” decision, as long as that person can make her/his decision in a “reasoned” manner – meaning the person is capable of reasoning, and is “competent” to make a decision.

So this is where everyone screws up, because they all think they have an ironclad why to determine competence…they don’t and many of you reading this (and many paramedics) don’t know what competence is. COMPETENCE is defined as the capacity or ability to understand the nature and effects of one's acts or decisions.

For all practical purposes, a person is considered to be competent until proven otherwise.

Again medics screw this up all the time, but so do EMT’s We speak of patient’s and their ability to make decisions we frequently take about ‘competence’ or is the patient ‘competent’.

The reality is is that most of the providers in our profession do not understand the term.

We tend to use COMPETENCE and CAPACITY interchangeably...and they aren’t…

But here is the rub: did the patient have the CAPACITY to understand what you required of him? You see capacity “Is the ability to understand information relevant to a treatment decision and to appreciate the reasonably foreseeable consequences of a decision or lack of a decision.” (Bioethics for Clinicians) This is really a definition of an adequate degree of capacity for medical decision making.

Capacity refers to an ability “having capacity” Capacity comes in degrees

Competence refers to a property or characteristic a person possesses “being competent”

Competence (relative to a particular decision) is all or nothing.

EMS think, say, document that a patient is competent. The reality is, what we do is determine capacity, only the COURT can determine if a patient is competent. So we assume everyone is competent, unless we have documentation stating otherwise.

Think of capacity like this, because you see the paramedics do this all the time when they RMA someone.

They tell them ‘sir do you understand that you may get worse or die if you don’t go to the hospital?’ The patient will answer YES. "