The majority of the literature relating to right of refusal of treatment and leaving AMA discusses the overall importance of assessing the patient’s level of competence, their understanding of the diagnosis and/or treatment, and the consequences of refusal and leaving. The literature equally stresses the importance of maintaining the patient’s autonomy and the patient’s right to self-determination.
Right of Refusal of Treatment
The United States Supreme Court and American Hospital Association states that patients who are competent and capable have the legal right to determine their own course of treatment. If a competent patient gives consent for treatment, then he/she can refuse treatment as well. …show more content…
However, many authors agree that the above assessments are missing the patient’s values and emotions which contribute to the patient’s ability in making competent health care decisions. Patients with anorexia nervosa are an excellent example of the need to assess a patient’s values, for this population requires healthcare providers to protect them from potentially harmful healthcare decisions (Craigie, …show more content…
The issue is that most patients will refuse only some of the care and the alternatives are usually not cost-effective. Consider the following examples of patients who refuse some form of medical treatment: the Jehovah 's Witness who refuses blood and requires erythropoietin to stimulate red blood cell production, the chronic smoker who refuses to quit but is requiring medical treatment for frequent respiratory illnesses, and the alcoholic who refuses detoxification and has developed liver failure. The right of refusal of treatment decreases the efficiency of care, the maximization of wellbeing, and the equality of outcome (Savulescu, 1998).
Leaving Against Medical Advice
When a patient leaves the hospital without an order for discharge or the physician’s approval, he/she is leaving AMA. There are a variety of reasons for which a patient might leave AMA. Patients might leave AMA because they need to care for someone at home such as a child or an elderly parent, they have financial obligations, or there were conflicts that arose with healthcare providers during treatment (Bartley, 2014).
The typical AMA patients are younger males who reside in a poor neighborhood and have a previous history of leaving AMA. Patients with a history of substance abuse, mental illness, and emotional problems are at an increased risk of leaving AMA, but the most significant are males who have