Despite numerous, sincere efforts to convince a 40-year-old man to consent to EMS treatment and transport, he refuses. After explaining the potential consequences and determining that he has decision-making capacity, you ask him to sign an EMS refusal form, but he refuses to do that as well. You should:

• A. Ask a family member, law enforcement officer, or bystander to sign the form verifying that the patient refused to sign.
• B. Force the patient to sign the form.
• C. Destroy the form and proceed as if the patient signed.
• D. Document the refusal and proceed without a signature.

Answer: (A)

When a competent patient refuses EMS care and won’t sign the refusal form, you need verifiable documentation that the refusal happened and was informed. The best approach is to have a witness sign the form to verify that the patient refused to sign. A witness can be a family member, law enforcement officer, or bystander who observed the patient’s decision. This protects the patient’s autonomy and provides an objective record that the refusal occurred and that the patient declined to sign, reducing questions later about whether the refusal was genuine or coerced. Forcing a signature or destroying the form would compromise ethics and legality, and proceeding without any witness can leave the refusal undocumented or disputed. If no witness is available, you would still document the refusal carefully and note the lack of a signature, but obtaining a witness when possible is the best practice.