“Can a doctor treat a patient who has refused treatment? Can a family member override the patient’s decision? And perhaps the most uncomfortable question: does a patient have the right to make a decision that the doctor believes is completely wrong?””
What happens when patient refused treatment?
Imagine this.
A doctor looks at a patient and says: “You need surgery.”
The patient listens carefully. Then comes the answer: “No.”
The doctor explains again. The patient still says no. The family becomes anxious.
“Doctor, please do something.”
But the patient remains firm.
What happens next?
Can a doctor treat a patient who has refused treatment? Can a family member override the patient’s decision? And perhaps the most uncomfortable question: does a patient have the right to make a decision that the doctor believes is completely wrong?
These are not merely medical questions.
They are questions about autonomy, dignity and the limits of medical authority.
The Right To Say No
Nigerian law provides an important starting point.
Section 23 of the National Health Act 2014 requires healthcare providers to give patients relevant information about their health condition, available diagnostic and treatment options, and the benefits, risks, costs and consequences associated with those options.
But the provision goes further. It expressly requires the healthcare provider to explain “the user’s right to refuse health services and explain the implications, risks or obligations of such refusal.”
The information should, where possible, be provided in a language the patient understands and in a manner appropriate to the patient’s level of literacy.
That is significant.
The law is not simply saying: “Here is the treatment. Sign here.”
It recognises something more fundamental.
A patient is entitled to information and to a choice.
The right to say no is therefore not necessarily an act of ignorance, stubbornness or ingratitude. It can be an exercise of autonomy.
But there is an important qualification.
For a refusal to be meaningful, the patient must understand what he or she is refusing. A patient cannot meaningfully exercise autonomy if the doctor has never explained the nature of the proposed treatment, its risks, alternatives and the consequences of declining it.
In simple terms:
The right to say no is meaningful only when the patient understands what “no” means.
When The Patient Is An Adult
Consider a competent adult who has been diagnosed with a serious illness.
The doctor recommends surgery.
The patient understands the diagnosis.
The doctor explains the procedure, the risks, alternatives and likely consequences of refusing.
The patient listens.
Then says:
“I understand. I do not want the operation.”
The decision may appear irrational. The family may disagree. The doctor may strongly believe that refusing treatment will result in serious harm.
But disagreement with the patient’s decision is not necessarily the same thing as incapacity to make it.
A competent adult does not surrender control over his or her body simply by entering a hospital.
The doctor has medical expertise.
The patient retains bodily autonomy.
The law must accommodate both.
Then Came Esabunor
One of the most important Nigerian cases in this area is Esabunor & Anor v Faweya & Ors (2019)
The case involved a seriously ill infant whose parents, Jehovah’s Witnesses, objected to a blood transfusion on religious grounds. The treating doctor believed that the child urgently required blood. The parents refused. The matter eventually reached the Supreme Court.
The Court drew an important distinction between the position of a competent adult and that of a child.
The Supreme Court recognised the right of a conscious adult of full mental capacity and sound mind to accept or refuse medical treatment. But it treated the situation of a child differently, emphasising the child’s welfare and best interests and the court’s protective jurisdiction.
That distinction matters enormously.
A parent ordinarily speaks for a child.
But a child is not the property of the parent.
Parental authority is not unlimited authority over another human being’s life.
Where a child’s welfare is seriously threatened, the law may intervene.
That is why the question “Who has the final word?” cannot always be answered simply by saying “the parent.”
Sometimes, the law gives the final word to the court.
What About “No Surgery Please”?
There is another Nigerian case that reveals a different difficulty.
In Otti v Excel-C Medical Centre Ltd & Anor (2019), the patient alleged that he had told his doctor that he did not want surgery.
There was, however, a written consent form referring to a particular procedure. The patient had also written “No Surgery Please” on the document.
The case ultimately turned on the evidence surrounding the consent form, what had been explained, what the patient had signed and the scope of the consent actually given.
The Court of Appeal upheld the finding that the consent covered the procedure performed.
There is an important lesson here.
Consent and refusal must be precise.
A patient saying “I don’t want surgery” may not resolve every question if, in context, the patient had consented to a particular procedure that he understood differently.
This is why medical conversations matter.
So do consent forms.
So does proper documentation.
A signature should not become a substitute for a genuine conversation.
But What About An Emergency?
Here the law becomes particularly interesting.
Section 20 of the National Health Act provides that a healthcare provider, health worker or health establishment shall not refuse a person emergency medical treatment for any reason.
Contravention of the provision is an offence punishable on conviction by a fine, imprisonment, or both.
At first glance, that sounds absolute.
But it is important not to confuse two different questions.
One question is:
Can a hospital refuse to provide emergency treatment?
Section 20 addresses that.
Another question is:
Can a competent patient refuse treatment that is offered?
Section 23 expressly recognises a patient’s right to refuse health services.
The existence of an emergency therefore does not, by itself, resolve every question about consent and refusal.
This is precisely why healthcare professionals need careful clinical and legal judgment rather than a simplistic rule that “emergency means treat regardless of consent.”
The Family Is Not The Patient
There is another scene familiar in Nigerian hospitals.
The patient says:
“I don’t want the procedure.”
The family says:
“Doctor, ignore him. We have agreed. Please save him.”
Families matter.
They provide emotional support, information and often practical assistance.
But where a competent adult has made an informed decision, family preference does not automatically become patient consent.
The patient is not simply a body belonging to the family.
The doctor is not simply an agent of the family.
And the family does not automatically acquire the right to decide what happens to a competent adult’s body.
That distinction becomes even more important when emotions are running high.
Saying No Does Not Mean Being Abandoned
There is, however, another side to autonomy.
Respecting a patient’s refusal does not mean abandoning the patient.
A doctor may still need to explain the consequences, discuss alternatives, provide appropriate continuing care, document the refusal and take reasonable steps to ensure that the patient understands the decision being made.
The Lagos State Patient Bill of Rights puts the principle in accessible language: patients may decline care and choose or change their healthcare provider, while healthcare providers are expected to communicate clearly and explain proposed treatment, risks and alternatives.
That is an important balance.
Respecting autonomy does not mean withdrawing compassion.
The Dignity Of Saying No
There is something profoundly human about a patient saying:
“I understand what you are recommending. I understand the risk. But I choose not to have it.”
The doctor may disagree.
The family may disagree.
The decision may even appear deeply unwise.
But the patient remains a person.
And the human body is not simply a medical project over which the doctor acquires ownership.
Health law exists partly because vulnerability creates an imbalance of power.
The patient enters the hospital because he needs help.
The doctor possesses knowledge the patient may not have.
That imbalance makes respect for autonomy even more important—not less.
The law must therefore protect the patient from both extremes: from being abandoned when vulnerable, and from being treated as though vulnerability has erased the right to decide.
Perhaps that is the real lesson.
The question is not simply:
“Who knows best—the doctor or the patient?”
It is:
“How do we respect the patient’s right to decide while ensuring that the decision is informed, voluntary and legally valid?”
That is where medicine meets law.
And that is where human dignity begins.
Because sometimes, the most important thing a doctor can hear from a patient is not:
“Yes, doctor.”
It is:
“I understand. But no.”
And when that happens, the law has a question to answer:
Is the patient entitled to have that “no” respected?
Section 23, National Health Act 2014: You have the right to receive relevant information about your health status, treatment options, and the benefits, risks, costs and consequences of each option.
You also have the right to refuse health services and to be informed of the implications, risks or obligations of that refusal.
Section 20, National Health Act 2014: A healthcare provider, health worker or health establishment shall not refuse a person emergency medical treatment for any reason.
Contravention is an offence punishable on conviction by a fine, imprisonment, or both.
Competent Adults: The Supreme Court has recognised that a conscious adult of full mental capacity and sound mind may accept or refuse medical treatment, including blood transfusion.
Children: Where a child’s welfare is seriously threatened, the courts may intervene where parental refusal conflicts with the child’s best interests.
Documentation: Consent and refusal should be clearly documented. A signature on a form is not a substitute for a genuine conversation.
•Sanu is a Nigerian lawyer and health law scholar. This column breaks down complex health laws for everyday Nigerians.
