• Kenneth D Marshall, Arthur R Derse, Scott G Weiner, and Joshua W Joseph.
• Department of Emergency Medicine and History and Philosophy of Medicine, University of Kansas Medical Center, Kansas City, Kansas. Electronic address: Kmarshall2@kumc.edu.
• J Emerg Med. 2024 Aug 1; 67 (2): e233e242e233-e242.

BackgroundFor many emergency physicians (EPs), deciding whether or not to allow a patient suffering the ill effects of opioid use to refuse care is the most frequent and fraught situation in which they encounter issues of decision-making capacity, informed refusal, and autonomy. Despite the frequency of this issue and the well-known impacts of opioid use disorder on decision-making, the medical ethics community has offered little targeted analysis or guidance regarding these situations.DiscussionAs a result, EPs demonstrate significant variability in how they evaluate and respond to them, with highly divergent understandings and application of concepts such as decision-making capacity, informed consent, autonomy, legal repercussions, and strategies to resolve the clinical dilemma. In this paper, we seek to provide more clarity to this issue for the EPs.ConclusionsSuccessfully navigating this issue requires that EPs understand the specific effects that opioid use disorder has on decision-making, and how that in turn bears on the ethical concepts of autonomy, capacity, and informed refusal. Understanding these concepts can lead to helpful strategies to resolve these commonly-encountered dilemmas.Copyright © 2024 Elsevier Inc. All rights reserved.

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