Can a patient refuse treatment? What the new law establishes

Refusing an indicated surgery, rejecting a blood transfusion or interrupting cancer treatment are decisions that challenge patients, families and healthcare professionals. In situations like these, an inevitable question arises: who decides about the treatment, the doctor or the patient?

Law No. 15,378/2026, which established the Statute of Patient Rights, brought a clearer response by bringing together in a single text guarantees that were previously dispersed in laws, resolutions of the Federal Council of Medicine and court decisions. The Statute establishes that everyone has the right to accept or refuse examinations, procedures and treatments, as long as their decision is free, conscious and based on adequate information about risks, benefits, alternatives and consequences.

The law also expressly recognizes the patient's self-determination and advance directives, a document in which the person registers in advance which treatments they accept or reject if, in the future, they are unable to express their wishes.

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The right to decide
Patient autonomy was not born with the Statute; the Code of Medical Ethics, the Organic Health Law and resolutions of the Federal Council of Medicine already recognized this principle. The novelty is to bring together these guarantees in a national law, offering greater legal certainty for patients and professionals.

Informed consent occupies a central position in this relationship, as informing does not just mean presenting a form for signature. The doctor must explain the diagnosis, the objectives of the treatment, the risks involved, the existing alternatives and the consequences of refusal. Only after this dialogue can the patient exercise their autonomy in a valid way.

The therapeutic decision continues to be constructed based on the doctor's technical knowledge, but the choice of accepting or not a certain intervention belongs, as a rule, to the patient.

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The courts' understanding
The Statute follows an interpretation that had already been consolidated by the Federal Supreme Court and the Superior Court of Justice.

In 2024, the STF decided that adult, capable and duly informed patients can refuse medical procedures, including when this decision involves a risk to their own life. The court also recognized the validity of advance directives.

The STJ adopted a similar understanding when stating that it is up to the patient to define the limits of medical action after receiving all the information necessary to make a conscious decision. The professional's role is to offer the best scientific knowledge available, allowing the patient to make choices compatible with their values and convictions.

When this right encounters limits
The patient's autonomy is not absolute and the law itself provides exceptions when there is an imminent risk of death, the patient is unconscious and there are no registered advance directives. In these circumstances, medical intervention is authorized to preserve life.

The situation is also different when it involves children and adolescents. In cases of urgency or emergency, the guardians' refusal may be overruled if it puts the minor's health or life at risk.

Each case requires individual assessment. The patient's capacity, clinical status, urgency of the situation and the existence of prior expression of will are factors that guide both medical conduct and eventual judicial analysis.

The duty to inform
The new legislation also increases the doctor's responsibility. Informed consent depends on a clear and understandable conversation, recorded in the medical record, so that it is demonstrated that the patient knew the risks, benefits and alternatives before deciding.

When a patient refuses treatment, it is recommended to document this decision in writing, whenever possible by signing an informed refusal form.

This registration protects the patient's rights and offers legal security to the professional.

In cases where the person cannot decide for themselves, such as situations of unconsciousness or incapacity, the law provides for the action of legal representatives. Still, conflicts can arise, especially in serious illnesses and admissions to intensive care units. In these situations, advance directives reduce uncertainty and help guide medical decisions.

The Patient Rights Statute reaffirms that access to healthcare is not limited to the right to receive treatment. It also includes the right to participate in decisions about one's own body. It is up to the doctor to indicate the most appropriate course of action based on the best scientific evidence available. It is up to the patient to decide whether to accept it or not, as long as this choice is free, conscious and informed.

*Article written by lawyers Ivani Pereira Baptista (OAB/SP 90.816), specialized in Medical Law, postgraduate in Hospital Administration from Faculdade São Camilo and specialist in Medical Law from Faculdade de Coimbra; and Demetrios Kovelis (OAB/SP 347.713), criminal lawyer, postgraduate in Business Administration from FGV and specialist in Economic Criminal Law from the University of Coimbra.

Source: CNN