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 https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread"> 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& #39;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
https://abs.twimg.com/emoji/v2/... draggable="false" alt="1⃣" title="Tastenkappe Ziffer 1" aria-label="Emoji: Tastenkappe Ziffer 1">understand relevant information (risks, benefits, alternatives)
https://abs.twimg.com/emoji/v2/... draggable="false" alt="2⃣" title="Tastenkappe Ziffer 2" aria-label="Emoji: Tastenkappe Ziffer 2">appreciate their situation and its consequences (how serious is this, what if I do nothing)
https://abs.twimg.com/emoji/v2/... draggable="false" alt="3⃣" title="Tastenkappe Ziffer 3" aria-label="Emoji: Tastenkappe Ziffer 3">reason with the information at hand (weigh it out according to their own priorities)
https://abs.twimg.com/emoji/v2/... draggable="false" alt="4⃣" title="Tastenkappe Ziffer 4" aria-label="Emoji: Tastenkappe Ziffer 4">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& #39;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 https://abs.twimg.com/emoji/v2/... draggable="false" alt="🪱" title="Worm" aria-label="Emoji: Worm">https://abs.twimg.com/emoji/v2/... draggable="false" alt="🪱" title="Worm" aria-label="Emoji: Worm">https://abs.twimg.com/emoji/v2/... draggable="false" alt="🪱" title="Worm" aria-label="Emoji: Worm">.]

8/10 Communicable diseases can complicate a person& #39;s individual rights to eschew parts of treatment that prevent spread: HIV, Tb, etc.

But as far as decisions about one& #39;s OWN health, patients have a lot of power here.

Me:

9/10 You can imagine the issue of deciding a patient& #39;s capacity to make certain decisions gets a lot more complicated when that patient is....let& #39;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?

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I see you all!