Interdisciplinary resources when patients want to leave hospital against medical advice
We commend your article “Management of vulnerable adult patients seeking to leave hospital: Understanding and using relevant legislation” [BCMJ 2021;63:106-111]. For consultation-liaison psychiatrists, capability assessments may be nuanced when patients have fluctuating lucidity or are under the coercive forces of addiction.
A few comments to supplement this extremely helpful article. Options include consulting the ethics service and risk management for perspectives that uphold nondiscrimination, balance harms and benefits, and respect the capable individual’s legal right to live at risk. Hospital social workers can liaise with the Re:Act team, which assesses adults when there is concern about their ability to access support in the community.
You mention the Public Guardian and Trustee (PGT) as a surrogate decision-maker either when there is no temporary substitute decision-maker (TSDM) or when appointed individuals cannot reach consensus. On your Figure, you might add the PGT at the bottom of panel #1, with an additional arrow to PGT after “NO” for emergency and “NO” for TSDM/consensus.
Documenting a second opinion is prudent if there is time before emergency treatment for which consent has not been obtained. For the middle of panel #1, we suggest: “YES” for emergency and “NO” for SDM, then “provide treatment without consent (with second opinion if possible).”
Trainees are benefiting from your superb summary of BC law. An interdisciplinary approach is ideal as there can be significant angst about limiting freedoms and failing to protect those who have lived their entire lives with risks that we ourselves have never taken.
—Stephen D. Anderson, MD, FRCPC
Clinical Professor, Department of Psychiatry, UBC Faculty of Medicine
—Carol P. Anderson, MD
Clinical Instructor, Department of Family Practice, UBC Faculty of Medicine
—Bethan Everett, MBA, PhD
VCH Ethicist, Clinical Professor, UBC Faculty of Medicine
This letter was submitted in response to “Management of vulnerable adult patients seeking to leave hospital: Understanding and using relevant legislation.”
Stephen D. Anderson, MD, FRCPC, Carol P. Anderson, MD, Bethan Everett, MBA, PhD. Interdisciplinary resources when patients want to leave hospital against medical advice. BCMJ, Vol. 63, No. 6, July, August, 2021, Page(s) 234 - Letters.
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