Devitt P J, Devitt A C, Dewan M
Department of Psychiatry, State University of New York Health Science Center, Syracuse 13210, USA.
Psychiatr Serv. 2000 Jul;51(7):899-902. doi: 10.1176/appi.ps.51.7.899.
Many physicians believe that documenting a discharge as "against medical advice" protects them from legal actions for adverse consequences related to the discharge. The authors examined case law for evidence of such protection.
MEDLINE and PsycINFO databases were searched for relevant articles. The medmal. base of Lexis and West Group was searched for annotated case law.
Four relevant cases were found in which medical authorities and physicians were sued for medical malpractice even though they discharged a patient against medical advice. In all cases the defendants prevailed. However, their success was not due to the fact that they used the procedure of discharging patients against medical advice. Rather, it was based on the plaintiffs' failure to prove negligence. The authors offer guidelines for physicians faced with the decision to discharge against medical advice. Physicians should perform a careful and well-documented examination. They should assess the severity of illness and the severity of the risk if the patient is discharged. They should engage in a constructive dialogue with the patient about grievances. They should ensure that the patient's withholding of consent for further hospitalization is informed with respect to risks, benefits, and alternatives. If the patient meets criteria for involuntary hospitalization, the patient should be committed.
Good clinical practice and thorough documentation remain the best legal protection. Discharging a patient against medical advice may provide partial protection, but it is not a royal road to legal immunity.
许多医生认为，将出院记录为“违背医嘱”可使他们免受因出院相关不良后果引发的法律诉讼。作者研究了判例法以寻找此类保护的证据。
检索MEDLINE和PsycINFO数据库以查找相关文章。检索Lexis和韦斯特集团的医疗事故数据库以查找注释判例法。
发现了四起相关案例，其中医疗当局和医生尽管违背医嘱让患者出院，但仍被起诉医疗过失。在所有案例中，被告均胜诉。然而，他们的胜诉并非因为他们采用了违背医嘱让患者出院的程序。相反，是基于原告未能证明存在过失。作者为面临违背医嘱让患者出院这一决定的医生提供了指导方针。医生应进行仔细且记录完善的检查。他们应评估疾病的严重程度以及患者出院后的风险严重程度。他们应与患者就不满之处进行建设性对话。他们应确保患者拒绝进一步住院的同意是在了解风险、益处和替代方案的情况下做出的。如果患者符合非自愿住院标准，应将其收治。
良好的临床实践和详尽的记录仍然是最佳的法律保护。违背医嘱让患者出院可能会提供部分保护，但并非获得法律豁免的捷径。
