Against Medical Advice Discharges: Considerations in the Psychiatric Population

  • Cynthia GeppertEmail author


This chapter reviews the concept of AMA discharges as it is applied to patients hospitalized in a psychiatric facility including the management of concomitant mental illness, determining criteria for commitment, and unique differences in this population. The epidemiology of AMA discharges from inpatient psychiatric hospitals is surveyed with attention to both patient and provider factors. The chapter then reviews the political and philosophical history of voluntary psychiatric admission in the United States. Current debates regarding the role of decision-making capacity, informed consent, and coercion in voluntary admission are analyzed as background to a consideration of the liability concerns and clinical implications of psychiatrists confronted with patient-initiated requests for discharge. Based on the literature and analysis, the chapter concludes with recommendations for preventive ethics strategies and best practices to reduce the frequency and improve the quality of AMA discharges from psychiatry for both patients and practitioners.


Against medical advice Discharge Psychiatry Inpatient Informed consent Coercion Decision-making capacity Legal Coercion Patient rights Voluntary admission 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of New Mexico School of MedicineAlbuquerqueUSA
  2. 2.Alden March Bioethics InstituteAlbany Medical CollegeAlbanyUSA

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