When patients come to the hospital, we enter into a fiduciary relationship with them. Essentially we promise to take care of them. We make recommendations and offer skilled interventions. We are motivated to do good for the patient (beneficence).
Implied in our promise is that we will avoid harm to the patient (non-maleficence). For the most part patients accept our help and follow the plan of care. So what should we do when a patient wants to leave against medical advice?
One of the great myths about leaving AMA is that a patient’s insurance company will not cover their current or future hospitalizations if they leave. This is not true. Insurance companies routinely have no way of knowing the circumstances surrounding a patient’s discharge.
To suggest this to a patient has the potential to damage the trusting relationship with the patient. It may send the message that you are more concerned about the hospital getting paid than you are about the health and well being of the patient.
Patients leaving AMA may not be denied prescriptions for discharge medications. Refusing to provide a prescription for a needed medication may constitute abandonment.
Nurses must follow established hospital procedures when a patient expresses a desire to leave before a physician is ready to officially discharge them.
Competent adult patients have the right to refuse treatment. What about our promise to help them? How far should we go in trying to convince a patient to stay in the hospital if we feel they are putting themselves at risk by leaving AMA?
We should inform them of the medical consequences of their choice. We can cajole them with gentle appeals and benevolent persuasion. However we must never coerce them with threats of financial hardship or medical abandonment.
Our fiduciary relationship with the patient is a mutual agreement. While it is certainly distressing to nurses when a patient rejects our care despite our best efforts and chooses to leave AMA, in the end, it is the patient’s decision.
Lucia Wocial, PhD, RN
Clarian Health Nurse Ethicist
To join the nurses at Clarian, visit Jobs for Registered Nurses
Implied in our promise is that we will avoid harm to the patient (non-maleficence). For the most part patients accept our help and follow the plan of care. So what should we do when a patient wants to leave against medical advice?
One of the great myths about leaving AMA is that a patient’s insurance company will not cover their current or future hospitalizations if they leave. This is not true. Insurance companies routinely have no way of knowing the circumstances surrounding a patient’s discharge.
To suggest this to a patient has the potential to damage the trusting relationship with the patient. It may send the message that you are more concerned about the hospital getting paid than you are about the health and well being of the patient.
Patients leaving AMA may not be denied prescriptions for discharge medications. Refusing to provide a prescription for a needed medication may constitute abandonment.
Nurses must follow established hospital procedures when a patient expresses a desire to leave before a physician is ready to officially discharge them.
Competent adult patients have the right to refuse treatment. What about our promise to help them? How far should we go in trying to convince a patient to stay in the hospital if we feel they are putting themselves at risk by leaving AMA?
We should inform them of the medical consequences of their choice. We can cajole them with gentle appeals and benevolent persuasion. However we must never coerce them with threats of financial hardship or medical abandonment.
Our fiduciary relationship with the patient is a mutual agreement. While it is certainly distressing to nurses when a patient rejects our care despite our best efforts and chooses to leave AMA, in the end, it is the patient’s decision.
Lucia Wocial, PhD, RN
Clarian Health Nurse Ethicist
To join the nurses at Clarian, visit Jobs for Registered Nurses
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