Challenging questions and ethical obligations: the ethics of everyday practice > 21 January 2015

Laura Machin


Past studies have found that up to 1.5 per cent of patients decide not to follow health professionals’ advice and were known to have discharged themselves from hospital [1, 2] This is significant when almost 15 million patients were admitted in the UK between 2009 and 2010 [3]. The reasons given for self-discharge include long waiting time, poor bedside manner, and failure of communication amongst hospital staff [4]. As a result, self-discharge has been framed in negative terms particularly as these patients have higher readmission and in-hospital mortality rates [5]. Yet, self-discharge could be perceived as an expression of patients’ rights. If patients are perceived as duty-bound to follow medical advice, self-discharge could offer a way of ‘equalling’ the balance of power between the two. So, how do self-dischargers and health professionals understand and make sense of the concepts ‘self-discharge’, and ‘self-dischargers’. Findings from an interdisciplinary two year pilot project will be reported. The findings are based on 32 qualitative interviews with self-dischargers and their carers (15) and health professionals (17) at two Northern Hospitals. The interview transcripts have been analysed for emerging themes and theoretical literature surrounding the doctor-patient relationship have been drawn upon to offer insight into the perceived position of the hospital patient, and the perceived role of health professionals within the hospital and community settings.


[1] Henson, V.L. & Vickery, D.S. (2005). Patient self discharge from the emergency department: who is at risk? Emergency Medicine Journal, 22, 499-501.

[2] Ibrahim, S.A., Kwoh, C.K. & Krishnan, E. (2007). Factors Associated With Patients Who Leave Acute-Care Hospitals Against Medical Advice. Am J Public Health, 97, 2204-2208.

[3] National Health Service. Hospital Episode Statistics (admitted patient care) England 2010-11.

[4] Onukwugha, E., Saunders, E., Mullins, C.D., Pradel, F.G., Zuckerman, M. & Weir, M.R. (2010). Reasons for discharges against medical advice: a qualitative study. Quality & Safety in Health Care, 19, 420-424.

[5] Choi, M., Kim, H., Qian, H. & Palepu, A. (2011). Readmission Rates of Patients Discharged against Medical Advice: A Matched Cohort Study. PLoS One, 6, e24459.



Broadly, my research interests rest within the social and ethical aspects of medicine. I have a particular interest in matters related to the donation of body parts, blood and tissue, the notion of dignity in practice, and research ethics. Throughout my research activities, I adopt an applied approach, whereby I consider the policy and practice implications of the topic under study. My research has tended to be interdisciplinary in nature, drawing on a wide range of literature from medical sociology and ethics, and focused upon accessing hidden populations and interviewing on sensitive subjects.


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