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

  • Jeffrey T. BergerEmail author
  • David Alfandre


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.


Against medical advice Ethics Power Shared decision-making Informed consent Autonomy Best interests 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Palliative Medicine and Bioethics, Department of MedicineNYU Winthrop HospitalMineolaUSA
  2. 2.VHA National Center for Ethics in Health Care, Department of Veterans AffairsNYU School of MedicineNew YorkUSA

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