Ethical decision or Patient's right?

I would not call. But i would clarify first that he would call their family when he got there and i would tell them if they called the department.

What is the policy about notifying family of any change in status? I assume that an ER visit is change in status. If the policy directs you to call, you need to do so. If the policy would allow for something like a call when the patient is back with you, just informing the family, then maybe that's what you do?

This is easy.

If the patient is his/her "own person" and has in fact instructed you not to notify or call people, you don't.

I'm in the ED and this is a frequent situation. Take college kids who are A&O but have an acute situation going on, for example.

I handle it by discussing it with them. These discussions have taken various forms and angles depending on the situation. Sometimes they actually have a very good reason (one that comes out only with additional discussion). Many times they say, "you're right, let's call them."

It doesn't matter if you know what the family would want. They are not the patient and they aren't legally charged with making the patient's decisions and your first duty is to your patient.

PS - I will say this: Depending on the type of "change in condition" I may be more direct - "That isn't a good idea; you are going to require X, Y, Z and you are going to need support. They will be scrambling to try to help you and it's best they have a head's up....etc., etc., etc."

One could probably make the case that in a situation where the patient has the competency and capacity to make current and ongoing decisions, the "emergency contact" policy (if there is one) doesn't come into play because the actual situation for which it is intended doesn't exist.

I agree with not calling, but I can't help but think if they had gone downhill even further once they left my care, I'm sure they would have wanted the family there. I understand some patients not wanting family to know because of private matters but this one in particular just didn't want to burden the family and I don't think they understood how critical their condition was.

If things go downhill then the receiving facility will have the emergency contact's number, and can call. Let them know the patient's wishes and do CYA charting.

Some ALF and Nursing Homes have all residents sign paperwork stating that their designated point of contact will be notified in the event that they are sent to the hospital. (I'm not sure from your post if you are sending the patient out from the nursing home or receiving the patient at the ED).