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Patient autonomy allows a competent adult to refuse evaluation or transport after informed discussion. Assess decision-making capacity: orientation, ability to understand information, appreciate consequences, and communicate a choice. Provide a clear explanation of suspected risks (e.g., ACS), benefits of transport, and alternatives (follow-up, calling back). If capacity is intact and no impairment from intoxication, hypoxia, or head injury is suspected, obtain an informed refusal signature per policy, including witness if available. Document the assessment findings, vital signs, ECG if performed, your education provided, the patient’s stated reasons, and explicit return precautions. Forcing transport without legal authority constitutes battery; law enforcement involvement is for safety threats or when a patient lacks capacity. Paramedic legal and ethical objectives stress consent, refusal, EMTALA interface, and meticulous documentation to protect patient rights and provider liability. Encourage re-contact if symptoms worsen and consider involving medical control for high-risk refusals.