Critically Ill Patient Leaving Against Medical Advice

Abstract

GJ is a 63-year-old male with a-1 antitrypsin deficiency (a-1) and a new lung mass. He presented to the emergency department (ED) complaining of dyspnea at rest and on exertion, with profound weakness. He was admitted for chronic obstructive pulmonary disease (COPD) exacerbation. GJ has been nonadherent with a-1 antitrypsin replacement therapy and is the primary caregiver for his wife who is disabled and diabetic. Staff was alerted when his continuous oxygen saturation monitor showed an oxygen saturation of 70% on high-flow nasal oxygen. When staff entered the room, patient was out of bed, with oxygen on, stating he wanted to leave the hospital immediately. The attending physician was called and GJ told her that he was worried about his wife, who had no one to administer her insulin. The attending told GJ that leaving the hospital would be against medical advice (AMA), and he responded "I don't care, I'm leaving and I'm driving home." During this exchange, GJ's oxygen saturation dropped to 69% and he had to sit down because he "felt faint." Blood pressure was 90/60 and heart rate was 114. The attending feels leaving the hospital would be harmful to GJ but wants to respect his autonomy. GJ has no one to provide transportation and the attending feels allowing him to drive would be a danger to the community. She does not want to restrain GJ against his will but also does not want to allow him to leave, specifically to drive. The attending asks for an emergency ethics consult.