ABSTRACT
Discharges against medical advice (AMA) make up a significant number of hospital discharges in the United States, and often involve vulnerable patients who struggle to obtain adequate medical care. Unfortunately, much of the AMA discharge process focuses on absolving the medical center of liability for what happens to these patients once they leave the acute setting. Comparatively little attention is paid to the ethical obligations of the medical team once an informed decision to leave the acute care setting AMA has been made. Via a case narrative, we offer an ethical framework that we believe can help guide an ethically defensible AMA discharge process. By emphasizing our duty to provide the best care possible under the circumstances, we contend, our ethical obligations to promote the patient's best interests can still be met despite their decision to leave the acute setting against medical advice.
Subject(s)
Patient Discharge , Treatment Refusal , Humans , Treatment Refusal/ethics , United States , Decision Making/ethics , Female , Vulnerable Populations , Male , Liability, LegalSubject(s)
COVID-19 , Family , Respiratory Distress Syndrome , Stress Disorders, Post-Traumatic , COVID-19/complications , Family/psychology , Humans , Intensive Care Units , Patient Discharge , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/therapy , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/etiologySubject(s)
Geriatrics , Decision Making , Humans , Intensive Care Units , Societies, Medical , United StatesSubject(s)
Adenosine Monophosphate/analogs & derivatives , Alanine/analogs & derivatives , Antiviral Agents/supply & distribution , Betacoronavirus , Coronavirus Infections/drug therapy , Healthcare Disparities/ethics , Pneumonia, Viral/drug therapy , Adenosine Monophosphate/supply & distribution , Alanine/supply & distribution , COVID-19 , Humans , Pandemics , Racism , SARS-CoV-2 , Social Justice , United StatesABSTRACT
People can experience moral distress when they regard themselves as expected to pursue a course of action they believe to be morally wrong. However, beliefs that give rise to moral distress are sometimes underdeveloped. Experiences of moral distress are not uncommon for medical trainees, who are still in the process of forming their professional identities and whose identity-constituting beliefs might therefore be subject to ongoing revision. Thus, it is important for health professions training programs to incorporate case-based ethics education sessions into their structure to help identify and alleviate trainees' moral distress, provide ethics education, and create a "safe space" for trainees to talk openly about moral concerns related to clinical practice. Such opportunities are crucial to the professional growth of trainees.
