Can I refuse treatment or leave hospital against medical advice in Peru?

The rule: no treatment without your consent

The page on informed consent covers what you must be told before a treatment. This page covers the other side: what happens when, having been told, you say no. Or when you want to leave hospital before the doctor discharges you.

The starting point is article 4 of Ley 26842, the General Health Law:

“Ninguna persona puede ser sometida a tratamiento médico o quirúrgico, sin su consentimiento previo o el de la persona llamada legalmente a darlo, si correspondiere o estuviere impedida de hacerlo. Se exceptúa de este requisito las intervenciones de emergencia. La negativa a recibir tratamiento médico o quirúrgico exime de responsabilidad al médico tratante y al establecimiento de salud, en su caso.”

(No one can be given medical or surgical treatment without their prior consent, or that of the person legally entitled to give it. Emergency interventions are exempt. Refusing treatment releases the treating doctor and the facility from liability.)

Three ideas in one paragraph. Your consent is required. Emergencies are the exception. And if you refuse, the doctor and the facility are not liable for that decision.

You can refuse a treatment, or stop one

Article 15.2(g) of the same law states it as a right:

“g) A ser informada sobre su derecho a negarse a recibir o continuar el tratamiento y a que se le explique las consecuencias de esa negativa. La negativa a recibir el tratamiento puede expresarse anticipadamente, una vez conocido el plan terapéutico contra la enfermedad.”

(You have the right to be told that you may refuse to receive or continue treatment, and to have the consequences explained. A refusal can be expressed in advance, once the treatment plan is known.)

Two things follow. First, you can refuse a treatment that has not started, and you can also ask for one already under way to stop. Article 15.4 backs this up by requiring your free consent before any procedure or treatment “así como su interrupción” (and also before stopping it). Second, you can decide in advance, but only after you know the treatment plan being proposed.

What the doctor must do, and what you sign

The regulation of Ley 29414 (Decreto Supremo 027-2015-SA), article 17, sets out the record:

“Toda persona debe ser informada por el médico tratante sobre su derecho a negarse a recibir o continuar el tratamiento y a que se le expliquen las consecuencias de esa negativa. El médico tratante debe registrar en la historia clínica del paciente que lo informó sobre este derecho, las consecuencias de su decisión, así como su aceptación o negativa en relación al tratamiento, consignando además la firma o huella digital del paciente o de su representante, según corresponda.”

(The treating doctor must tell you about your right to refuse and explain the consequences, then record in your medical file that you were informed, the consequences, and whether you accept or refuse, with your signature or fingerprint.)

So your refusal goes into your historia clínica (medical record), signed or with your fingerprint. Before signing, check that the consequences were explained. That explanation is the doctor’s duty, not a favour.

Voluntary withdrawal: leaving before medical discharge

What people call alta voluntaria (leaving against medical advice) is called retiro voluntario in the regulation. Article 16 says:

“Toda persona usuaria de los servicios de salud o su representante en el caso de lo establecido en el artículo 5 del presente reglamento, podrá decidir su retiro voluntario del servicio o de la IPRESS; para tal efecto, deberá expresar al médico tratante por escrito esta decisión, dejando constancia que la misma se ejerce voluntariamente, sin presión alguna y que ha sido informado de los riesgos que asume por tal decisión, consignándose expresamente los mismos y, entregándole una copia de esa información con cargo de recepción. Asimismo, debe consignarse en la historia clínica haber recibido la información, que será firmada por el paciente o su representante y el médico tratante, eximiendo de responsabilidad a este último y a la IPRESS.”

(Any patient may decide to withdraw voluntarily from the service or facility. To do so, you state the decision in writing to the treating doctor, confirming it is voluntary, made without pressure, and that you were told the risks, which must be written down expressly. You get a copy of that information with a receipt. The medical record notes that you received the information, signed by you and the doctor, releasing the doctor and the facility from liability.)

(IPRESS is the acronym the regulation uses for the health facility.)

So what you can be asked to sign is a written statement to the treating doctor saying:

• that you are leaving voluntarily and without pressure;
• that you were told the risks, and what they are, written out expressly.

And what you must be given: a copy of that risk information, with a receipt. The same article adds that you can ask for a free copy of your epicrisis and a copy of your medical record at your own cost. See free epicrisis vs. paid medical record copy.

What “released from liability” means

Both article 4 of the law and article 16 of the regulation say your decision releases the doctor and the facility from liability. The logic is simple: if the risks were explained and you chose not to be treated, or to leave, they cannot answer for what follows from that choice.

What the norm does not say is that your signature erases poor care given before. Our reading is that the release covers the consequences of your refusal or withdrawal, not earlier errors. If you think there was one, see the page on medical malpractice.

When it is not allowed: emergencies and public health

This is the limit that matters most. Article 16 of the regulation ends:

“La decisión de retiro voluntario de la IPRESS no procede cuando la persona usuaria del servicio de salud se encuentre en estado de emergencia o cuando éste ponga en riesgo la salud pública.”

(Voluntary withdrawal is not allowed when the patient is in a state of emergency or when it puts public health at risk.)

Article 17 says the same about refusal:

“La negativa a recibir o continuar el tratamiento no procede cuando la persona usuaria del servicio de salud se encuentre en estado de emergencia o esta decisión ponga en riesgo la salud pública.”

(Refusing to receive or continue treatment is not allowed when the patient is in a state of emergency or the decision puts public health at risk.)

The law, in article 15.4, also exempts from consent situations “de emergencia, de riesgo debidamente comprobado para la salud de terceros o de grave riesgo para la salud pública” (of emergency, of a duly proven risk to the health of others, or of serious risk to public health).

The norms we read do not define what counts as a “state of emergency” for this purpose, and do not explain what happens in practice if a patient in an emergency insists on leaving. If you are in that position, ask the doctor to write in your medical record why they consider you to be in an emergency.

Can the hospital hold you?

Outside an emergency or a public health risk, the regulation recognises your right to leave. And one kind of holding is prohibited in every case: holding you to get paid. Article 70 of Decreto Supremo 013-2006-SA says:

“Queda terminantemente prohibido que el establecimiento de salud retenga o pretenda retener a cualquier usuario o cadáver para garantizar el pago de la atención médica prestada, o cualquier otra obligación.”

(A health facility is strictly prohibited from holding, or trying to hold, any patient or body to secure payment for the care given or any other obligation.)

If you are told you cannot leave until you pay, or until your insurer’s carta de garantía (guarantee letter) arrives, read patient detention for non-payment.

If it is about a child, or someone who cannot decide

This page is about adults deciding for themselves. When parents refuse a treatment for their child, the rules change: the doctor must notify a judge and the public prosecutor takes part. See medical decisions for a minor child.

If you are pressured

If you are refused a withdrawal without explanation, or pressured to sign something different from what the norm describes, ask to speak to the medical director and record it in the Libro de Reclamaciones en Salud. If that does not resolve it, you can go to SUSALUD. The deadlines are on patient complaints to SUSALUD. If you arrive in an emergency, your admission rights are on emergency care rights.

What this page does not cover

• Involuntary mental health admissions, which have their own regime under Ley 30947.
• Advance directives beyond what article 15.2(g) says, palliative care and end-of-life decisions.
• The actual “alta voluntaria” forms each hospital or clinic uses: we did not review technical standards or internal forms.
• How a voluntary withdrawal affects your insurance, SIS or EsSalud cover: it depends on each scheme and we did not verify it.
• Court rulings or SUSALUD decisions on specific cases.