In Reply Dr Querques and colleagues advance the dialogue on this important topic. We disagree, however, with their characterization of SDM and wish to clarify how it might apply to discharges against medical advice.
Querques and colleagues contend that the against medical advice designation can be a sign of professionalism and an articulation of the physician’s values that a patient’s health is important. We are troubled by their description of a clinical scenario that squares a physician’s values against a patient’s because we believe that it is inconsistent with the intent of SDM. Procedurally distinct from a decision-making capacity assessment, SDM seeks to elicit a patient’s values and preferences for care to decide about an appropriate treatment in light of the risks, benefits, and alternatives as described by the physician.
Alfandre D, Schumann JH. Discharges Against Medical Advice—Reply. JAMA. 2014;311(17):1808-1809. doi:10.1001/jama.2014.1481