[3] The individual needs to be in possession of the relevant facts as well as of their reasoning faculties, such as not being intellectually disabled or mentally ill and without an impairment of judgment at the time of refusing.
Such impairments might include illness, intoxication, drunkenness, using drugs, insufficient sleep, and other health problems.
While in the past documentation of refusal of treatment has not been important, the widespread use of managed care, cost containment processes, as well as increased patient autonomy have created a situation where documented "informed refusal" is viewed as becoming more important.
[3] When refusal of treatment may result in significant damage or death, the interaction needs to be documented to protect the care giver in a potential later litigation against the allegation that the recommendation was either not made or not understood.
[1] The pregnant patient represents a specific dilemma in the field of informed refusal as her action may result in harm or death to the fetus.