i just finished reading on the internet details on a court case, marsingill v. o'malley. some things were mentioned in the discourse that i would like some clarification on. a lady (marsingil) called her physician (o'malley) at home with complaints of nausea, bloat, abdominal pain, inability to burp, and constipation. dr. o'malley said he could not evaluate her over the phone, but if she felt bad enough to call him at home at night she should go the emergency room. she questioned the doctor as to what might happen at the er? doctor stated they would probably take x-rays and insert a nasogastric tube to relieve the pressure in her stomach. she had previously had nasogastric tube inserted, and on hearing she would likely receive this procedure again, ended the call, telling the doctor that she thought she could now burp and felt better and ended the call. patient's husband later found her unconscious on the floor and summoned ems. it was discovered that she experienced an intestinal blockage which caused her to go into shock, from which she suffered brain damage and partial paralysis. when her family filed a lawsuit, one of their expert witnesses testified the doctor's actions fell below the standard of care, stating that a competent physician who wanted to encourage a patient to seek emergency room treatment would not have offered the possibility of being treated with a painful procedure of inserting a nasogastric tube. i guess the crux of my question concerns E.R. ethics and protocols. what would have occurred in the emergency room when patient got there? if she refused insertion of nasogastric tube, they could not force her, is that not correct? i know there are certain instances in er protocol where patient is considered not competent to make medical decisions, and treatment could then be forced on her. would this be one of those times? are N.G. tubes really that awful? i decided to go ahead and ask this question as it really has very little to do with the lawsuit per se. thank you very much.