You get paged to see Mr S. who is a 40M admitted with infective endocarditis. He is receiving IV abx (day 2) and requesting to go home. What do you do?

You get paged to see Mr S. who is a 40M admitted with infective endocarditis. He is receiving IV abx (day 2) and requesting to go home. What do you do?

• A. If still wishes, assess capacity to decide; if capacity present, respect autonomy
• B. Address any concerns and reasons for staying
• C. Explain the risks if he self-discharges
• D. If patient is resistant and continues wanting to self-discharge after open discussion, then may need to assess capacity - ?confusion from being unwell

Answer: (A)

Decision-making capacity and patient autonomy are being tested here. When a patient requests to leave hospital against medical advice, you must first determine whether they have the capacity to make that decision. Capacity is decision-specific and hinges on four abilities: understanding the information about the condition and proposed plan, appreciating the consequences of the decision, reasoning about options, and communicating a clear choice. Illness can affect capacity, but you shouldn’t assume incapacity simply because the patient is unwell; you should assess it directly. If the patient demonstrates capacity, his autonomous choice must be respected—even if you disagree or believe staying is safer. You should still provide clear information about risks and discuss his concerns, but you would not coerce him to stay. If capacity is lacking, you would involve appropriate safeguards or decision-makers and consider ethics consultation as needed. The other actions—addressing concerns or explaining risks—are important parts of the conversation, but they assume capacity and do not substitute for a proper capacity assessment.

Decision-making capacity and patient autonomy are being tested here. When a patient requests to leave hospital against medical advice, you must first determine whether they have the capacity to make that decision. Capacity is decision-specific and hinges on four abilities: understanding the information about the condition and proposed plan, appreciating the consequences of the decision, reasoning about options, and communicating a clear choice. Illness can affect capacity, but you shouldn’t assume incapacity simply because the patient is unwell; you should assess it directly.

If the patient demonstrates capacity, his autonomous choice must be respected—even if you disagree or believe staying is safer. You should still provide clear information about risks and discuss his concerns, but you would not coerce him to stay. If capacity is lacking, you would involve appropriate safeguards or decision-makers and consider ethics consultation as needed.

The other actions—addressing concerns or explaining risks—are important parts of the conversation, but they assume capacity and do not substitute for a proper capacity assessment.