J Med Ethics 36:652-655 doi:10.1136/jme.2010.035600
  • Clinical ethics

A case study from the perspective of medical ethics: refusal of treatment in an ambulance

  1. Selim Kadıoğlu1
  1. 1Department of Deontology and History of Medicine, Cukurova University, Adana, Turkey
  2. 2Cukurova University Adana Health High School, Department of Midwifery, Adana, Turkey
  1. Correspondence to Dr Hasan Erbay, Cukurova University, Department of Deontology and History of Medicine Balcali Kampusu 01330 Yuregir, Adana, Turkey; hasanerbay{at}
  • Received 22 January 2010
  • Revised 17 May 2010
  • Accepted 13 June 2010
  • Published Online First 26 July 2010


This paper will examine a sample case encountered by ambulance staff in the context of the basic principles of medical ethics.

An accident takes place on an intercity highway. Ambulance staff pick up the injured driver and medical intervention is initiated. The driver suffers from a severe stomach ache, which is also affecting his back. Evaluating the patient, the ambulance doctor suspects that he might be experiencing internal bleeding. For this reason, venous access, in the doctor's opinion, should be achieved and the patient should be quickly started on an intravenous serum.

The patient, however, who has so far kept his silence, objects to the administration of the serum. The day this is taking place is within the month of Ramadan and the patient is fasting. The patient states that he is fasting and that his fast will be broken and his religious practice disrupted in the event that the serum is administered. The ambulance doctor informs him that his condition is life-threatening and that the serum must be administered immediately. The patient now takes a more vehement stand. ‘If I am to die, I want to die while I am fasting. Today is Friday and I have always wanted to die on such a holy day,’ he says.

The ambulance physician has little time to decide. How should the patient be treated? Which type of behaviour will create the least erosion of his values?


  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.