Refusal or leaving against advice

• Emergency → consent cannot be obtained in time and treatment is needed now to save life or a limb or prevent serious harm: the doctor acts (Law 70/2020, art. 11). Call the senior.
• Is it the illness talking? → delirium, hypoglycemia, hypoxia, intoxication, withdrawal. Check glucose and vitals, treat the cause. delirium
• Tell the senior now → before a sick patient walks out, not after.

• Listen first → pain, waiting, fear, a child or job at home, a conflict with staff, not understanding the plan.
• Fix what you can → analgesia, a clear plan with times, a call to the family, the consultant to speak to them.
• Offer a middle way → part of the treatment, oral instead of IV, the test tomorrow morning. Partial care beats none.

Law 70/2020, art. 12: before consent or refusal is accepted, the doctor checks two things.

• Aware → conscious, and oriented to time, place, their own identity and the people around them.
• Understands → the nature of the illness, the treatment options, and the known and possible complications of each, judged for their age, education and work.
• Either missing → the patient is not able to consent or refuse.
• Two witnesses → the assessment is done in front of two witnesses (doctors or allied health staff) and written in the file.

At the bedside it helps to hear them say it back in their own words, and why they choose it (Appelbaum 2007).

• Not able → senior now. Consent can come from the father, mother, spouse, an adult relative to the second degree, or the legal representative (art. 11). Mental illness: psychiatry.

• What we recommend → and why, in plain words.
• The real risk → say the worst outcome if it applies: “you could have a heart attack at home and die.”
• The alternatives → including the middle way.
• They can come back → any time, without penalty.
• Check → “tell me what you will do if the pain comes back.”

Law 70/2020, art. 30: the patient may refuse or withdraw at any time without giving a reason. The team respects it and records it in the file after telling them the consequences. The doctor still owes them care, by offering medical alternatives.

• Unsafe to go home alone → senior; arrange family or transport before they leave.
• Before they go → remove the cannula; prescriptions; pending results and who will act on them; follow-up appointment.
• Return precautions → the specific symptoms that mean come back now, or call 112.
• AMA form → the patient signs the hospital AMA form. It does not replace your note.

• Recommended → what, and the specific risks explained.
• Capacity → findings, and the two witnesses’ names.
• Reason → the patient’s, in their words.
• Offered → alternatives, prescriptions, follow-up, return advice.
• Informed → senior, consultant, family, by name and time.

Reviewed October 2026 against Kuwait Law No. 70 of 2020 on the practice of medicine and patients’ rights (articles 11, 12 and 30, official text), Appelbaum, Assessment of patients’ competence to consent to treatment (N Engl J Med 2007), and Alfandre, Improving quality in against medical advice discharges (J Hosp Med 2017). Hospital forms and out-of-hours routes follow your hospital’s policy.