Leaving Against Medical Advice: What's a Nurse to Do?

Each year approximately 1% to 2% of patient acute care discharges in United States hospitals are described as against medical advice (AMA). AMA discharges are associated with higher patient morbidity, increased risk of readmission, and higher mortality. Most discussions dealing with AMA discharge tend to focus on physicians. However, nurses have a pivotal role in the care process and in ensuring the safety of patients. The aim of this paper is to increase awareness regarding nurses' ethical responsibilities when confronting AMA discharges. We highlight nurses' leadership role in discharge planning and argue that they have moral obligations to promote as safe a discharge as possible. Such obligations are consistent with nursing codes of ethics, according to which nurses have a primary moral duty to promote patients' well-being. Moreover, nurses' training, expertise, and scope of practice place them in an ideal situation to address problems related to AMA discharges. We also offer suggestions that can contribute to helping nurses to fulfill their ethical responsibilities in this context.