Leaving Against Medical Advice - Article Example

A physician has the responsibility of explaining to the patient the benefits, risks, and alternatives to enable the patient to make informed decisions or give informed consent. The nurse has the duty of acting as the patient’s advocate and playing a key role in getting patients to consider the consequences or alternatives of refusing or accepting care (Weingart et al, 2009).

The nurse ought to document all efforts to give the patient the necessary information to decide whether to accept or refuse care. Documentation, thus, ought to be objective including information such as the date, time, who spoke with the patient, the content of the information that the patient was given, the comments that the patient made, and the final disposition. Documentation of details such as telephone numbers, names, and referrals made by the nurse should be given to the patient on discharge with a listing or description of any instructions given verbally or preprinted forms (Pennycook et al, 2011).

Proper documentation would be done in the body of the chart of patient. Other elements to be documented would be their capacity for decision-making, the decision of the patient, the risks that were revealed, the patient’s understanding of the risks, and the signatures of both the physician and the patient. It is advisable to use a comprehensive AMA form to increase proper documentation. Emergency physicians ought to assess the AMA form to ensure that it is adequate, and in cases where a patient declines to sign the AMA form, the physician is expected to read it aloud, keep documentation of refusal to sign including the fact that the patient was made aware of the risks of leaving (Schaefer, 2012).

With the prevalence of against medical advice medical discharges and the severe problems that they present, physicians of emergency departments always make attempts to prevent patients from leaving against medical advice, but when it is unavoidable, three requirements are normally expected to be met so that the AMA process can grant optimal legal protection; the patient should be considered to have the capacity to refuse care, disclosure of all potential risks to the patient, and the against medical advice consent be documented properly in the chart (Brown, 2012).

Since the law dictates the patient’s right to refuse medical care, and since treatment without consent could be considered battery, at the point where a patient signs out AMA, they are exercising this right of refusing medical care. Should it be determined that the patient is incapable of making the decision, then it will be unethical and illegal for the physician to allow a discharge that could lead to imperiling the life and health of the patient. In as much as a patient has the legal right to refuse medical care, the exercising of this right is solely dependent on the patient’s capacity for decision-making. A formal assessment would normally be done on the patient to determine their decision-making capacity (Brown, 2012).

The ethical obligation of disclosure of all risks associated with the patient’s leaving AMA is a secondary tool and requirement for risk management. It is also worth noting that the appearance of the patient’s signature on the AMA form does not necessarily give a reflection of informed consent (Westrick & Dempski, 2009).

It is normally expected of the emergency physician to discuss thoroughly with the patient the consequences and risks and consequences of leaving AMA. A consent that is considered informed would entail information disclosure, comprehension by the patient, and voluntariness. The patient ought to be asked to confirm their understanding of the disclosed information and show a rational basis for choosing to leave AMA. The physician’s role in properly informing the patient is vital since lack of it may lead to legal liability despite the patient’s refusal of care (Patterson & Friedman, 2008).

In some cases, signing out AMA form may lead to a termination of the physician’s legal duty to treat. With AMA cases, a crucial issue is whether or not a duty to treat was in existence or not at the time of the injury of the patient which comes up with the development of the patient-physician relationship. If the relationship is absent, the physician does not have a duty toward the patient and cannot be answerable for negligence (Weingart et al 2009).

AMA forms and procedures may not give complete protection to emergency physicians from liability in an action of medical malpractice but those that are properly executed have the capability of conferring vital legal protection. It doesn’t however, give total immunity against suit. An AMA discharge that is performed properly may entitle a physician or medical care provider to the additional defense of risk assumption. The appropriate disclosure of potential risks and documentation of the discussions held with the patient is capable of supporting the defense and if it is proven, the risk assumption defense can utterly circumvent the finding of negligence. The assumption of risk defense would normally be used in scenarios where patients signed out of an emergency department against appropriate medical advice bearing in mind the disclosed potential risks associated with leaving AMA (Westrick & Dempski, 2009).