Kavanagh Aifric, Ostrow Olivia, Zlotnik Shaul Randi
Department of Bioethics, The Hospital for Sick Children, Toronto, Ontario.
Division of Pediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario.
Paediatr Child Health. 2020 Feb;25(1):12-15. doi: 10.1093/pch/pxz052. Epub 2019 Apr 18.
Requests for discharge against medical advice are often challenging for clinicians to navigate, especially when the patient is a child. An informed, standardized approach to managing situations where children and their families are requesting to leave against medical advice is essential to maximizing safety and ethics for patients and staff, yet such situations are often not handled this way. Paediatric discharge against medical advice (DAMA) requests are best managed when clinicians ensure the patient's best interests are met, understand and act upon their professional obligations, and engage in guided discussion with patients and families that involves both shared and informed decision-making strategies. A process map can capture these criteria and readily provide clinicians with a bedside reference tool when managing paediatric DAMA requests.
对于临床医生来说，处理违背医疗建议出院的请求往往颇具挑战，尤其是当患者为儿童时。采用一种明智、标准化的方法来处理儿童及其家属要求违背医疗建议出院的情况，对于最大限度地保障患者和工作人员的安全与道德规范至关重要，但此类情况往往并未如此处理。当临床医生确保患者的最大利益得到满足、理解并履行其职业义务，以及与患者及其家属进行涉及共同和明智决策策略的引导性讨论时，儿科违背医疗建议出院（DAMA）请求能得到最佳处理。流程图可以涵盖这些标准，并在处理儿科DAMA请求时为临床医生提供便捷的床边参考工具。
