Introduction: Refusal of recommended surgical treatment is a common and challenging clinical scenario, particularly in life threatening or life altering circumstances. Surgeons must navigate complex medico legal obligations whilst ensuring good medical practice Methods: A structured scoping review was conducted in accordance with alongside a targeted review of Australian state health department policies and publications from major medico legal companies. Results: Five key themes emerged through thematic analyses: 1.Sources emphasised ethical principles of patient autonomy, respect and the right of a competent adult to refuse treatment, even where consequences are serious or fatal. 2.High risk refusals may require formal capacity assessment, with specialist/psychology. 3.Clinicians have a clear obligation to provide informed consent regarding risks, benefits, alternatives, and consequences of refusal. 4.Comprehensive documentation was universally identified as essential for medico legal protection with particular importance in exploring reason for refusal. 5.Risk mitigation strategies were recommended: offering alternatives, MDT discussion, second opinions, involvement of support person and follow up planning. Termination of the therapeutic relationship may be necessary. Conclusion: While patient autonomy remains paramount in this potentially stressful situation, recommendations exist but lack formal national guidance. This may contribute to clinician uncertainty. This review provides themes and robust considered strategies on navigating these challenging scenarios. 1. Zolkefli Y. Patient refusal of care: balancing patient autonomy and professional ethical duties. J Client‑Centered Nurs Care. 2024;10(3):231–234. doi:10.32598/JCCNC.10.3.63.1/ 2. Avant Mutual Group. When patients do not follow your advice [Internet]. Sydney: Avant Mutual Group; 2024 Sep 5 [cited 2026 Jan 22]. Available from: https://avant.org.au/resources/when-patients-do-not-follow-your-advice