But those are my values, and I have neither the right to impose them on him nor any reason to allow that difference to cast doubt on his decisional capacity.

Getting back to the particular case in New York, it is important to understand that a high blood alcohol level does not necessarily mean that a patient lacks decisional capacity. People who are habitual drinkers are often lucid and able to carry on coherent and rational conversation with blood alcohol levels that would render me unconscious.

They are also often able to walk with a steady gait and cross streets carefully and safely. So, when we are deciding when a person who has been brought to the ED drunk can be safely discharged, we base that on whether the person can “walk and talk” normally (among other things), not on any number.

So let us assume, for the sake of argument, that the man in the New York case made his intent to leave known to ED personnel rather than deceiving them and slipping out of the building unnoticed. Did they consider his decision to be against medical advice? Did they think it was unsafe for him to leave? Did they assess his decisional capacity? Did they consider restraining him (either with tranquilizing drugs or with physical restraints), thus violating his autonomy in order to protect him? (Such decisions are not always straightforward, because restraints of either kind carry their own risks.) These are all the questions I would ask if I were reviewing the case and judging it for its adherence to principles of biomedical ethics.

While I consider it important to avoid violating the law in my practice of medicine, I consider it even more important to avoid violating principles of biomedical ethics.

If I obey the law but violate professional ethics – and I’m not saying that’s what happened in the New York case, as I think should be clear by now – that will not help me to sleep at night if there is a tragic outcome.

Dr. Solomon has served on hospital ethics committees for 25 years and on the ethics committee of the American College of Emergency Physicians for 15 years. He teaches emergency medicine to residents at Allegheny General Hospital in Pittsburgh and is Medical Editor in Chief of ACEP News. He is a social critic and political pundit and blogs at www.bobsolomon.blogspot.com.