When Can Clinicians Refuse an AMA Discharge Request? The Ethical Challenge

Joel Wu, JD, MPH, MA, HEC-C, Center for Bioethics University of Minnesota

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When Can Clinicians Refuse an AMA Discharge Request? The Ethical Challenge of AMA Discharges and Involuntary Hospitalization

This session of Unpacking Bedside Bioethics explores how conflicts between ethical commitments to respect patient autonomy and to prevent avoidable harms to patients arise when patients try to leave the hospital before it is safe to leave. On one hand, involuntary hospitalization is a serious intrusion on individual liberty, and the methods to keep a patient involuntarily hospitalized may be coercive and harmful on their own. On the other hand, allowing patients with impairments in decision making capacity to leave when it is medically unsafe can lead to avoidable and sometimes serious harms that may not only be harmful to the patient’s health, but also adverse to their own true goals and values. This session addresses the ethical considerations and procedures for evaluating when a discharge against medical advice (an AMA discharge) is ethically appropriate, or when involuntary hospitalization is ethically appropriate.

Learning Objectives: By attending this webinar, participants will be able to:

-Explain when an AMA discharge is ethically appropriate.
-Explain when involuntary hospitalization may be ethically defensible.
-Describe ethical and procedural considerations for either involuntary psychiatric holds, or medical incapacity holds.

Unpacking Bedside Bioethics is a quarterly professional development seminar series delivered by the Center for Bioethics. Speakers discuss foundational bioethics concepts, identify ethical dilemmas in clinical cases, & explain how to apply bioethical frameworks to resolve those dilemmas. This interprofessional series is designed for professionals who work in health related fields and health professions students. This is an event of the Office of Academic Clinical Affairs (OACA), hosted by the Center for Bioethics.

Certificate of Attendance will not be given for watching the recording - only for those attending the zoom session.

Speaker: Joel Wu, JD, MPH, MA, HEC-C, is a Center for Bioethics’ Clinical Ethics Assistant Professor and a senior lecturer in the Division of Health Policy and Management at the University of Minnesota’s School of Public Health.Joel Wu, JD, MPH, MA, HEC-C, is a Center for Bioethics’ Clinical Ethics Assistant Professor and a senior lecturer in the Division of Health Policy and Management at the University of Minnesota’s School of Public Health. Professor Wu’s primary role is as a clinical ethicist for the MHealth Fairview system. He is a co-chair of the University of Minnesota Medical Center's Ethics Committee, co-lead for the clinical ethics consultation service for MHealth Fairview system hospitals, and member of the MHealth Fairview Ethics Council. Professor Wu also teaches courses at the intersection of clinical ethics, public health ethics, and public health law.

Previously, Professor Wu conducted health policy research and development at the National Academies of Sciences, Engineering, and Medicine at the Institute of Medicine (now the National Academy of Medicine) where he served as a study director on the Board on the Health of Select Populations and the Board on Population Health and Public Health Practice. Professor Wu also worked as a research associate for the former Engelberg Center for Health Care Reform at the Brookings Institution and completed post-doctoral fellowships at the Program in Bioethics and Professionalism at the Mayo Clinic in Rochester, MN, and in Clinical Ethics at Children's Minnesota and Abbott Northwestern Hospitals in Minneapolis, MN. Professor Wu holds a JD and an MA in Bioethics from Case Western Reserve University and an MPH in Epidemiology from the University of Minnesota.