Risk Management for the Emergency Physician: Competency and Decision-Making Capacity, Informed Consent, and Refusal of Care Against Medical Advice

Committee Opinion No. 664

“…Genuine differences in how obstetrician-gynecologists and patients assess and balance risk; the pregnant woman's assessment of the collective interests of herself, her fetus, her family, or her community; and religious beliefs and cultural meanings of interventions may all lead decisionally capable patients to choose options other than those strongly recommended by their obstetrician-gynecologists (25). Disagreement with a physician's recommendation is not, per se, evidence of decisional incapacity.…”

The Importance of a Proper Against-Medical-Advice (AMA) Discharge: How Signing Out AMA May Create Significant Liability Protection for Providers

“…Approximately 1-2% of discharges at acute care hospitals in the United States are AMA; this figure goes up to 6% in disadvantaged inner-city populations (1,2). A study at a major academic medical center found that about 2.7% of patients left the ED AMA (3).…”

“…Of note, concerning complaints such as non-specific chest pain and abdominal pain are often presenting problems among patients who eventually leave AMA (3). Table 1 illustrates some of the more common complaints and characteristics of patients who sign out AMA (2,3). The purpose of this article is to explore the legal requirements of the AMA process and to examine the legal protections that can be created by properly executed AMA discharges.…”

Taking No for an Answer—Refusal of Life-Sustaining Treatment

“…To use it, physicians must navigate between respecting patient autonomy and protecting patients from the possibly mortal consequences of a bad decision [2]. In the end, what must be proven is that a patient made an autonomous decision based on maximizing self-interest as he or she defines it, even though the choice was not the expected or physician-recommended choice for the majority of patients facing the same decision [8].…”