In summary, many of the complex medicolegal and ethical issues surrounding the prehospital patient who refuses all or part of the care offered by the EMS system have been reviewed. The best outcome can be achieved using a sliding scale of capacity and a conservative approach to treatment rather than releasing the patient at the scene. Finally, the roles of collateral history, inquiries as to the origin of the patient's refusal of care, direct physician interaction with the patient, a spirit of creativity and compromise in dealing with the patient, meticulous documentation, and policy issues have been discussed.