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Can This Patient Leave Against Medical Advice?

By Catherine A. Marco, MD, FACEP | on March 10, 2025 | 0 Comment
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ACEP Now: March 02

Dr. Marco is professor of emergency medicine at Penn State Health-Milton S. Hershey Medical Center and associate editor of ACEP Now.

 

 

References

  1. Simon JR. Refusal of care: the physician-patient relationship and decision-making capacity. Ann Emerg Med. 2007;50:456-461.
  2. Calienes Cerpa F, Anthony Colucciello S. Understanding Against Medical Advice, Informed Consent, and Emergency Medical Treatment and Labor Act. Emerg Med Clin North Am. 2025;43(1):139-154.
  3. National Center for Health Statistics. National Hospital Ambulatory Medical Care Survey: 2021 Emergency Department Summary Tables. Accessed January 7, 2025.
  4. Jeong J, Song KJ, Kim YJ, et al. The association between acute alcohol consumption and discharge against medical advice of injured patients in the ED. Am J Emerg Med. 2016;34(3):464-468.
  5. Ti L, Ti L. Leaving the hospital against medical advice among people who use illicit drugs: a systematic review. Am J Public Health. 2015;105(12):e53-59.
  6. Hoyer C, Stein P, Alonso A, et al. Uncompleted emergency department care and discharge against medical advice in patients with neurological complaints: a chart review. BMC Emerg Med. 2019;19(1):52.
  7. Marco CA, Bryant M, Landrum B, et al. Refusal of emergency medical care: an analysis of patients who left without being seen, eloped, and left against medical advice. Am J Emerg Med. 2021;40:115-119.
  8. Goff SL, Mazor KM, Meterko V et al. Patients’ beliefs and preferences regarding doctors’ medication recommendations. J Gen Intern Med. 2008;23:236-241.
  9. American College of Emergency Physicians: Code of Ethics for Emergency Physicians. Approved October 2023. Accessed January 7, 2025.
  10. Marco CA, Brenner J, Krauss C, et al. Refusal of emergency medical treatment: case studies and ethical foundations. Ann Emerg Med. 2017;70(5):696-703.
  11. Larkin GL, Marco CA, Abbott JT. Emergency determination of decision making capacity: balancing autonomy and beneficence in the emergency department. Acad Emerg Med. 2001;8:282-284.
  12. Appelbaum PS. Assessment of patients‘ competence to consent to treatment. N Engl J Med. 2007;357:1834-1840.
  13. Bremault-Phillips SC, Parmar J, Friesen S, et al. An evaluation of the Decision-Making Capacity Assessment Model. Can Geriatr J. 2016;19:83-96.
  14. Finney GR, Minagar A, Heilman KM. Assessment of mental status. Neurol Clin. 2016;34(1):1-16.
  15. Palmer BW, Harmell AL. Assessment of healthcare decision-making capacity. Arch Clin Neuropsychol. 2016;31:530-540.
  16. Folstein MF, Folstein SE,McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatric Research. 1975;12(3):189-198.
  17. Nasreddine ZS, Phillips NA, Bedirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4);695-699.
  18. Carney MT, Neugroschl J, Morrison RS, et al. The development and piloting of a capacity assessment tool. J Clin Ethics. 2001;12(1):17-23.
  19. Levy F, Mareiniss DP, Iacovelli C. The importance of a proper against-medical-advice (AMA) discharge: how signing out AMA may create significant liability protection for providers. Amer J Emerg Med. 2012;43(3):516-520.
  20. Monico EP, Schwartz I. Leaving against medical advice: facing the issue in the emergency department. J Healthc Risk Manag. 2009;29(2):6-15.
  21. ACEP. Use of patient restraints. Policy statement. Ann Emerg Med. 2014;64(5):574.

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Topics: against medical adviceEthicsLegalpatient restraintsPractice ManagementQuality & Safetyrefusing treatment

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