Abstract：
In emergency, physicians are confronted with obligations that may appear in opposition: assistance to a person in danger and consent to care. Knowing the seriousness of acute coronary syndromes, the cardiologist in front of an ignorant patient should not too quickly resolve himself to accept a refusal. In 2 clinical cases, the different means to obtaining consent are recalled: the evocation of the risks in the absence of care (death, physical incapacity, professional aptitude, heavy treatments) taking into account the psychology of the patient, without him make them lose face, by reassuring them about the steps of the procedure, while explaining the lower effectiveness of other therapies (loss of chance). The participation of all medical and paramedical actors makes it possible to match a psychology adapted to the patient\'s profile, to prevent an incompatibility of mood leading to death by refusal of care. More than ever, the cardiologist has an \"obligation\" to implement \"all means\". If the refusal persists, it will be necessary to find the most effective alternative and to get the patient to return to the optimal strategy by a rapid contact, by involving his family and his attending physicians, who will be informed without delay, with remission of prescriptions. To protect themselves from possible prosecution, the healthcare team will record in detail the course of the events, as well as a detailed document of the refusal of care, signed by the patient who acknowledges having been informed of the risks involved.
摘要：
在紧急情况下,医生面临着可能出现的反对义务:援助处于危险中的人和同意护理。知道急性冠脉综合征的严重性,在无知患者面前的心脏病专家不应该太快地下决心接受拒绝。在2例临床病例中，回顾了获得同意的不同手段：在没有护理的情况下唤起风险(死亡，身体无行为能力，专业能力,重治疗)考虑到患者的心理，没有他让他们丢脸，通过向他们保证程序的步骤，同时解释其他疗法的有效性较低（失去机会）。所有医疗和辅助医疗行为者的参与使得有可能匹配适应患者概况的心理学，以防止因拒绝护理而导致死亡的情绪失调。比以往任何时候都多,心脏病专家有“义务”实施“一切手段”。如果拒绝持续,有必要找到最有效的替代方案，并通过快速联系使患者恢复到最佳策略，通过让他的家人和主治医生参与进来，谁将立即被告知，处方缓解。为了保护自己免受可能的起诉，医疗团队将详细记录事件的过程，以及拒绝护理的详细文件，由患者签名，该患者承认已被告知所涉及的风险。
