Abstract
Patients who wish to leave the hospital against medical advice (AMA) present physicians with a common but challenging ethical dilemma. Physicians are obligated to respect patient’s autonomy when patients choose treatment consistent with their values, needs, and preferences. However, physicians also have a fiduciary obligation to promote the patient’s best interest by recommending medically appropriate care. This chapter will provide guidance in managing this ethical dilemma by reviewing the construct of medical advice giving, examining the central role of power in that process, describing the process of shared decision-making and how it promotes strong ethics practices in informed consent, and exploring the role of surrogates in the AMA process.
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the U.S. Department of Veterans Affairs, the US Government, or the VA National Center for Ethics in Health Care.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Suggested Reading
Alfandre D. Reconsidering against medical advice discharges: embracing patient-centeredness to promote high quality care and a renewed research agenda. J Gen Intern Med. 2013;28(12):1657–62. https://doi.org/10.1007/s11606-013-2540-z. Epub 2013 Jul
Alfandre D. Clinical recommendations in medical practice – a proposed framework for reducing bias and improving decision quality. J Clin Ethics. 2016;27(1):21–7.
Beauchamp TL, Childress JF. Principles of biomedical ethics. 7th ed. New York: Oxford University Press; 2012. p. 137–8.
Berger JT. Discharge against medical advice: ethical considerations and professional obligations. J Hosp Med. 2008;3(5):403–8. https://doi.org/10.1002/jhm.362.
Berger JT, DeRenzo EG, Schwartz J. Surrogate decision making: reconciling ethical theory and clinical practice. Ann Intern Med. 2008;149:48–53.
Brody H. The healer’s power. New Haven: Yale University Press; 1993.
Fischer MA, Stedman MR, Lii J, Vogeli C, Shrank WH, Brookhart MA, Weissman JS. Primary medication non-adherence: analysis of 195,930 electronic prescriptions. J Gen Intern Med. 2010;25(4):284–90.
Lekas HM, Alfandre D, Gordon P, Harwood K, Yin MT. The role of patient-provider interactions: using an accounts framework to explain hospital discharges against medical advice. Soc Sci Med. 2016;156:106–13. https://doi.org/10.1016/j.socscimed.2016.03.018. Epub 2016 Mar 15
Tollen WB. Irregular discharge: the problem of hospitalization of the tuberculous. Public Health Rep. 1948;63(45):1441–73.
Windish DM, Ratanawongsa N. Providers’ perceptions of relationships and professional roles when caring for patients who leave the hospital against medical advice. J Gen Intern Med. 2008;23:1698.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
Berger, J.T., Alfandre, D. (2018). Ethical Considerations in Against Medical Advice Discharges: Value Conflicts Over Patient Autonomy and Best Interests. In: Alfandre, D. (eds) Against‐Medical‐Advice Discharges from the Hospital. Springer, Cham. https://doi.org/10.1007/978-3-319-75130-6_4
Download citation
DOI: https://doi.org/10.1007/978-3-319-75130-6_4
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-75129-0
Online ISBN: 978-3-319-75130-6
eBook Packages: MedicineMedicine (R0)