Refusal of life-saving therapy can be a challenging situation in the practice of emergency medicine. Emergency physicians recognize informed consent and informed refusal of care as basic rights of patients, and honor patient-centered wishes of adults with decisional capacity. In all cases of refusal of care, decisional capacity should be evaluated, and if the patient is deemed to have decisional capacity, the physician should communicate with them regarding the proposed interventions, risks, benefits, and alternatives, and the patient's goals and values. When a patient refuses medical treatment, care should specifically be taken to ensure that the patient understands the consequences, and that the physician expresses a willingness to treat the patient, including providing reasonable alternative treatments, as well as providing appropriate follow-up recommendations. The voluntary decision of the patient regarding medical care and important aspects of the discussion should be documented in the medical record.