In this Ethics Rounds we present a conflict regarding discharge planning for a febrile infant in the emergency department. The physician believes discharge would be unsafe and would constitute a discharge against medical advice. The child’s mother believes her son has been through an already extensive and painful evaluation and would prefer to monitor her well-appearing son closely at home with a safety plan and a next-day outpatient visit. Commentators assess this case from the perspective of best interest, harm-benefit, conflict management, and nondiscriminatory care principles and prioritize a high-quality informed consent process. They characterize the formalization of discharge against medical advice as problematic. Pediatricians, a pediatric resident, ethicists, an attorney, and mediator provide a range of perspectives to inform ethically justifiable options and conflict resolution practices.
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January 2022
Ethics Rounds|
December 03 2021
Pediatric Discharge From the Emergency Department Against Medical Advice
Meaghann S. Weaver, MD, MPH, PhD, FAAP;
aDepartment of Pediatrics, University of Nebraska, Omaha, Nebraska
bVA National Center for Ethics in Health Care, Washington, District of Columbia
Address correspondence to Meaghann S Weaver, MD, MPH, FAAP, Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, 68198. E-mail: meweaver@childrensomaha.org
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Haavi Morreim, JD, PhD;
Haavi Morreim, JD, PhD
cUniversity of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee
dCenter for Conflict Resolution in Healthcare LLC, Memphis, Tennessee
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Lydia H. Pecker, MD;
Lydia H. Pecker, MD
eDivision of Hematology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Rachel O. Alade, MS, MPH;
Rachel O. Alade, MS, MPH
fDepartment of Pediatrics, University of Pittsburgh, Pittsburg, Pennsylvania
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David J. Alfandre, MD, MSPH
David J. Alfandre, MD, MSPH
bVA National Center for Ethics in Health Care, Washington, District of Columbia
gDepartment of Medicine and Department of Population Health, New York University, New York, New York
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FINANCIAL DISCLOSURES: The authors have indicated they have no financial relationships relevant to this article to disclose.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
Address correspondence to Meaghann S Weaver, MD, MPH, FAAP, Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, 68198. E-mail: meweaver@childrensomaha.org
Pediatrics (2022) 149 (1): e2021050996.
Article history
Accepted:
September 20 2021
Citation
Meaghann S. Weaver, Haavi Morreim, Lydia H. Pecker, Rachel O. Alade, David J. Alfandre; Pediatric Discharge From the Emergency Department Against Medical Advice. Pediatrics January 2022; 149 (1): e2021050996. 10.1542/peds.2021-050996
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