Against‐Medical‐Advice Discharges from the Hospital

1. Front Matter

   Pages i-xii

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2. Ethical, Legal, and Empirical Considerations

   1. Front Matter

      Pages 1-1

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   2. Introduction

      • David Alfandre

      Pages 3-9

   3. Discharges Against Medical Advice: Prevalence, Predictors, and Populations

      • Madhuram Nagarajan, Ada Ibe Offurum, Mangla Gulati, Eberechukwu Onukwugha

      Pages 11-29

   4. Legal Considerations of Patient Refusals of Treatment Against Medical Advice

      • Arthur R. Derse

      Pages 31-40

   5. Ethical Considerations in Against Medical Advice Discharges: Value Conflicts Over Patient Autonomy and Best Interests

      • Jeffrey T. Berger, David Alfandre

      Pages 41-51

   6. Reframing the Phenomenon of Discharges Against Medical Advice: A Sociologist’s Perspective

      • Helen-Maria Lekas

      Pages 53-71

   7. Social Justice and the Ethics of Care: A Nursing Perspective

      • Jamie L. Shirley

      Pages 73-81

3. Preventing and Managing Against Medical Advice Discharges Across the Spectrum of Care

   1. Front Matter

      Pages 83-83

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   2. Bedside Management of Discharges Against Medical Advice

      • Holly Fleming, David S. Olson Jr., David Alfandre, Cynthia Geppert

      Pages 85-105

   3. Against Medical Advice Discharges from the Emergency Department

      • Jay M. Brenner, Thomas E. Robey

      Pages 107-123

   4. To Thy Own Self Be True: Contributions from Consultation-Liaison Psychiatry

      • Nicole Allen, Philip R. Muskin

      Pages 125-141

   5. Against Medical Advice Discharges: Pediatric Considerations

      • Armand H. Matheny Antommaria

      Pages 143-157

   6. Against Medical Advice Discharges: Considerations in the Psychiatric Population

      • Cynthia Geppert

      Pages 159-176

4. Back Matter

   Pages 177-181

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This first-of-its-kind text provides a multidisciplinary overview of a significant problem in hospital-based healthcare:  patients who decline inpatient medical care and leave the hospital against medical advice (AMA).   Compared to standard hospital discharges, AMA discharges are associated with worse health and health services outcomes.   Patients discharged AMA have been found to have disproportionately higher rates of substance use, psychiatric illness, and report stigmatization and reduced access to care.  By providing a far reaching examination of AMA discharges for a wide academic and clinical audience, the book serves as a reference for clinical care, research, and the development of professional guidelines and institutional policy.  The book provides both a broad overview of AMA discharges with chapters on the epidemiology, ethical and legal aspects, as well as social science perspectives.  For clinicians in the disciplines of hospital medicine, pediatrics, emergency medicine, nursing, and psychiatry, the book also provides a patient-centered analysis of the problem, case-based discussions, and a discussion of best practices.  This comprehensive review of AMA discharges and health care quality will interest physicians and other health care professionals, social workers, hospital administrators, quality and risk managers,  clinician-educators,  and health services researchers.

• AMA discharge
• consultation-liaison psychiatry
• institutional liability
• substance use
• ethics

“This is a valuable and well-timed contribution to the clinical literature. Considering the frequency and clinical significance of AMA discharges, this book should be a common feature of both personal and institutional medical libraries. Clinicians may be most motivated to read it for the frank discussions of liability and documentation.” (Michelle Bach, Doody's Book Reviews, August, 2018)

• VHA National Center for Ethics in Health Care, Department of Veterans Affairs, NYU School of Medicine, New York, USA

  David Alfandre

David Alfandre, MD, MSPH

VHA National Center for Ethics in Health Care

US Department of Veterans Affairs

Associate Professor of Medicine and Population Health

NYU School of Medicine

New York, NY, USA

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