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Your first patient of the day is Mr. J. M., a very nice 58 year old man who was visiting his brother here in town when he became ashen, sweaty and admitted to his family that he was having chest pains. His brother insisted on bringing him to the Emergency Department, where his EKG shows ST depressions in V4, V5 and V6. The lab calls you with a critical result: his troponin is 130 (negative: under 0.01). You return to the patient's bedside, where he remains stable appearing and says he feels much better. A repeat EKG shows ST elevations in the anterior leads V1 and V2. You explain to him that he is having a heart attack and the treatment is cardiac catheterization to re-establish blood flow to his heart in order to prevent more damage to his heart and possibly save some injured heart muscle. He thoughtfully responds "I would prefer not to stay in the hospital - I feel okay now and I don't like hospitals. I want to go home." He is sober, alert and oriented, and can express your concerns when you ask him to demonstrate understanding of the situation. He states "I just don't feel like I should stay in the hospital if I'm not having pain. I feel fine now. I will come back if anything happens. I'd prefer to go home now - can you discharge me?" What do you do?
1. Would you discharge J.M. from the hospital?
2. Would you make him leave against medical advice (AMA)?
3. Would you refuse to let him leave?
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