When a
patient
requests
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discharge of a
patient
, the medical
staff
must
first
check whether the
patient
is capable of making decisions on his own. The
patient
's decision-making
ability
means the capacity to understand the
patient
's condition and necessary treatment procedures after receiving sufficient information related to prescription from the medical team, compare the benefits and risks of each medication method, and make reasonable decisions according to the evaluation results. The following four basic factors can be used to objectively evaluate a
patient
's decision-making
ability
. (1) Can the
patient
accurately convey his or her choice to the medical
staff
? (2) Does the
patient
fully understand his medical condition and treatment methods? (3) Does the
patient
understand the benefits and risks of his or her choice? (4) Can the
patient
properly explain the reason for his or her decision-making?If all four of the above questions fall under 'yes', the medical crew can determine that the
patient
has decision-making
ability
.
On the other hand
,
judgment
on a
patient
's decision-making qualification should be made more strictly if there is a high risk of fatal consequences when discharged from the hospital. It was judged that the decision-making skill was not intact for emergency patients who refused remedies
such
as gastric lavage by visiting the emergency room after drinking pesticides with the purpose of suicide. In
this
case, the court evaluated that the
patient
has no decision-making
ability
due to medical conditions
such
as drinking and pesticide addiction, and if there are any medical problems (addiction, pain, fever, withdrawal symptoms, etc.), immediate therapy should be performed. 1. In principle, it is necessary to respect the
patient
's decision. The principle of respect for autonomy is one of the four principles of medical ethics, meaning the right of patients to decide and reject therapy or cure to be implemented on them. When grasping decision-making
ability
, it is evaluated whether the
patient
can explain the reason for decision-making, and at
this
time, it is necessary to check whether external factors
such
as economic factors are involved. The final responsibility for the decision-making of the
patient
must be informed that the
patient
himself or herself is responsible, and the medical
staff
is obligated to explain to the
patient
in advance about possible medication methods, treatments, and possible risks. 2. According to the
Patient
Care Act, if a
patient
does not have the qualification to make a determination, it is required to explain the medical practice to the legal representative who will make the
patient
's agreement and obtain consent. The criterion for
judgment
when making a proxy doctor is to
first
follow the compromise intention specified by the
patient
in advance.
This
is the case in which there is a record of the
patient
's intention, or when a family member or close person is informed of the preferred treatment. The criterion for estimation
judgment
is to make a decision based on the operation choice that the
patient
has previously preferred, and care should be taken not to reflect the purpose of the medical
staff
or agent, and if there is an insufficient basis for estimation of the
patient
's decision. It is stated that if the
patient
himself or herself is in a state where it is difficult to express his or her aim, the medical personnel should respect the plan and
judgment
of the
patient
's representative,
such
as his or her family, but try to appreciate and ensure the
patient
's usual intentions and interests as much.