Grand Rounds at the Johns Hopkins Hospital Section Editors: John H. Stone, MD, MPH, Charles Weiner, MD, Stephen D. Sisson, MD, The Johns Hopkins Hospital, Baltimore, Md; David S. Cooper, MD, Contributing Editor, JAMA .
Author Affiliations: Department of Medicine, Johns Hopkins Bayview Medical Center, and Program on Ethics in Clinical Practice, Phoebe R. Berman Bioethics Institute, Johns Hopkins University.
Honoring patients' wishes becomes difficult when doing so threatens their well-being. In this article, the case of a hospitalized elderly woman is presented. The patient, ready for discharge, insists on returning home, yet she is bedbound and lacks adequate social support and financial resources to manage safely. The medical team, troubled by this situation, requests an ethics consultation. The article discusses several issues related to the difficult ethical problem posed by this case, including a brief historical review of the patient's role in decision making, current thinking about patients' rights vis-à-vis patients' well-being, assessing patients' capacity to make sound decisions, consideration of physician values, and, finally, responding to patients' refusal of care.
Carrese JA. Refusal of Care: Patients' Well-being and Physicians' Ethical Obligations: “But Doctor, I Want to Go Home”. JAMA. 2006;296(6):691–695. doi:10.1001/jama.296.6.691
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