A 56-year-old man is admitted to hospital with pyelonephritis and started on intravenous antibiotics.

The patient is alert and capable of making his own decisions. The most ethical and respectful approach is to ensure he understands the risks and accept his choice. Holding his bed maintains continuity of care. Forcing him to stay (C) or discharging him AMA (A) is inappropriate if he intends to return.

Toronto Notes 2023 – ELOM, Consent and Autonomy:

“Capable patients have the right to refuse or leave treatment. Physicians must ensure informed decision-making and maintain therapeutic rapport.”

MCCQE1 Objectives – ELOM > Capacity and Patient Autonomy:

“Candidates must respect a capable patient’s right to leave care after informed discussion of risks and alternatives.”

Offering to enter his apartment (E) is inappropriate and unethical. Oral antibiotics (B) may not be clinically appropriate given hypotension.

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