Too sick to leave AMA?

[Rexie]

Normally, if a pt wants to leave AMA, we'll call the doctor to come speak with them and if they still want to leave, we'll ask the pt to sign the AMA papers, and off they go. There are variations, of course. Some patients have been threatening AMA for days. Some are with us frequently and this is their pattern. Some patients have concerns or issues that we can resolve and they'll stay. But what happens if somebody is really ill and they want to leave AMA and not give us the chance to get some type of discharge plan together or if they're too sick to be discharged with any type of plan?

I had a doctor recently want to section somebody because he thought they were too sick to leave and if they wanted to leave being that sick, they much be irrational. It eventually resolved without getting to that point but we nurses were very uncomfortable with the whole scenario.

I'm curious what others experiences with this are.

[Scrubs_n_sirens, MSN, RN]

I've been in PA for several years now, and I've never heard of a "medical commitment." A 302 petition is to detain people with psychiatric conditions for psychiatric evaluation in a psychiatric facility. Is there somewhere in the state that you can use a 302 to hold people for medical treatment against their will? That would never fly in my county. No wonder physicians in your area are reluctant to get involved; that's likely to get someone in serious trouble at some point.

It's a very last ditch situation. I'm not sure what the legal term for it is but if a physician feels that a patient will die for sure and isn't in a position to be making the decision to leave, they can petition with a second physician to keep that patient. I am trying to find the PA CODE

[calivianya, BSN, RN]

Why in the **** is family given so much power over people over age 18 and clearly expressing wishes?? Even simple wishes like refusing the med in the RN's hand? Competent people have the right to autonomy. Why is it difficult to say, "this pain med is ordered, she needs it, and she's getting it?" Or "She is a&o, she just refused her med. Legally I can't give it; it's a form of battery."

I really don't understand.

It's just like elkpark said - I've never had someone sue me for keeping them alive (most of my patients in that sort of situation end up dying anyway, eventually) but family is going to sue if we let them die. The US is way too lawsuit happy. It's easier just to go with the flow and help slowly torture the patient to death than it is to be the person that tries to do the right thing and gets screamed at by the families, maybe even threatened with physical violence, and gets sued on top of all of that.

It's awful. Patient families are my least favorite part of nursing. I would say around half of my patients have zero chance of having any sort of decent life when they leave me (as in, probably won't ever leave the hospital, will at best survive to go to LTACH), and of those with awful prognoses, I expect more than half of them to die in my unit before they get a chance to transfer anywhere. It's always the family that wants to press on past the point of all reason. It's not the physicians and it's sure as hell not the nurses that want to do all this stuff to the patients.

Families just don't understand that we can't fix everything. There are too many medical dramas on TV where somebody codes, a hot physician does one round of compressions and shocks an unshockable rhythm, and the patient sits up in the bed and shakes the physician's hand. Nobody is realistic anymore. If you try to be realistic and tell the family the patient is going to die, they look at you like you've grown three heads and complain about you to patient relations.

The last night I worked, we had five people who have been with us for weeks, who are similar to the situation I mentioned above in that they are never getting better and family wants us torturing them. Fortunately, four are unconscious and never waking up again. One, however, just screams all the time at the top of her lungs because she is so deeply distrustful of healthcare professionals and she's in pain. You can hear her from five rooms away, even with the door closed. She has been with us since the end of April. Family has refused palliative care. I just want to ask her kids if she beat them as a child or something, and that's why they want her to suffer. If I have to take care of her one more time, I swear to God I'm going to snap and do it.

[MunoRN, RN]

It's not unheard of for a patient to decline treatment, if it's a life-threatening condition then we don't really think of it as AMA, it's a patient choosing comfort care / allow natural death. We'll often have the patient fill out a POLST which helps avoid confusion after they leave the ED.

[MunoRN, RN]

It's just like elkpark said - I've never had someone sue me for keeping them alive (most of my patients in that sort of situation end up dying anyway, eventually) but family is going to sue if we let them die. The US is way too lawsuit happy. It's easier just to go with the flow and help slowly torture the patient to death than it is to be the person that tries to do the right thing and gets screamed at by the families, maybe even threatened with physical violence, and gets sued on top of all of that.

It's awful. Patient families are my least favorite part of nursing. I would say around half of my patients have zero chance of having any sort of decent life when they leave me (as in, probably won't ever leave the hospital, will at best survive to go to LTACH), and of those with awful prognoses, I expect more than half of them to die in my unit before they get a chance to transfer anywhere. It's always the family that wants to press on past the point of all reason. It's not the physicians and it's sure as hell not the nurses that want to do all this stuff to the patients.

Families just don't understand that we can't fix everything. There are too many medical dramas on TV where somebody codes, a hot physician does one round of compressions and shocks an unshockable rhythm, and the patient sits up in the bed and shakes the physician's hand. Nobody is realistic anymore. If you try to be realistic and tell the family the patient is going to die, they look at you like you've grown three heads and complain about you to patient relations.

The last night I worked, we had five people who have been with us for weeks, who are similar to the situation I mentioned above in that they are never getting better and family wants us torturing them. Fortunately, four are unconscious and never waking up again. One, however, just screams all the time at the top of her lungs because she is so deeply distrustful of healthcare professionals and she's in pain. You can hear her from five rooms away, even with the door closed. She has been with us since the end of April. Family has refused palliative care. I just want to ask her kids if she beat them as a child or something, and that's why they want her to suffer. If I have to take care of her one more time, I swear to God I'm going to snap and do it.

The right of a patient to have their wishes followed, and our requirement to abide by those wishes, are pretty well established legally. While it's probably true that families who disagree with the patient's wishes that we are following are more likely to pursue legal action than the patient in these situations, it's unlikely to go anywhere. On the other hand, patients or people who represent the patient when their wishes aren't followed also pursue legal action if we violate the patient's expressed wishes, and it's those situation we should be more worried about since there's a decent chance it could result in loss of license, successful civil suit, and even criminal charges/jail time.

Personally, I'll take being named in 100 nuisance suits that go nowhere over losing my license and becoming a felon.