Lots of talk about the Walter Reed medical team "letting" the president leave the hospital, whether for a joyride or to be discharged to the White House.

A on having the capacity to leave against medical advice (AMA):
1/10

2/10 Physicians can strongly recommend patients stay in the hospital when they don't want to (and we often do!) but short of a judicial order like we get in psych hospitals, patients are free to make their own choices, regardless of how bad we might think those choices are.

3/10 The exception would be a patient who seemed to be making those choices because of some kind of impairment that renders them incapable of doing the 4 things required for medical decision-making capacity:

4/10
understand relevant information (risks, benefits, alternatives)
appreciate their situation and its consequences (how serious is this, what if I do nothing)
reason with the information at hand (weigh it out according to their own priorities)
communicate a clear choice

5/10 The threshold for deciding someone lacks capacity is higher if the consequences are higher. Like a 3-year-old might have the capacity to refuse wearing socks, but not to refuse wearing a seatbelt.

6/10 "Capacity" is a clinical decision and can be made by any treating physician (though consultation highly recommended!)

"Competence" is a legal term, not applicable to leaving AMA, used for things like competence to stand trial, competence to act as one's own attorney, etc.

7/10 So if someone were, e.g., delusional that their medical team were trying to poison them, they might be determined to lack capacity to refuse a highly beneficial treatment.

[What happens next, e.g. how that plays out, is a whole separate can of .]

8/10 Communicable diseases can complicate a person's individual rights to eschew parts of treatment that prevent spread: HIV, Tb, etc.

But as far as decisions about one's OWN health, patients have a lot of power here.

Me:

9/10 You can imagine the issue of deciding a patient's capacity to make certain decisions gets a lot more complicated when that patient is....let's say for example, THE PRESIDENT OF THE UNITED STATES AND YOUR BOSS

I really hope I am never called for this capacity consult. Ever.

10/10 Probably every doctor has wished they had the power to make a patient do something that doctor felt was in their best interest.

But... how many doctors out there have failed to follow their doctors advice when THEY were the patient?


I see you all!