Here’s a disturbing and important New York Times article detailing two studies showing that physicians were more likely to use negative language in the medical record about Black patients than about those of other races. 

Medical notes from emergency departments and inpatient settings were more likely to use this pejorative language, possibly because of a lack of long-standing relationships with patients.

Along these lines, a term like “refused” should not be used in the medical record. If we, as medical professionals, believe the patient is truly in charge of his/her body, “declined” is an appropriate replacement.