title: [The long road home: a discussion of the autonomy of schizophrenia patients after their discharge from the hospital].
abstract: Every adult has the right to self-determination and to have his or her autonomy respected. While schizophrenia patients have the right to be discharged from the hospital, their needs subject their caregivers to high care loadings. This situation presents a dilemma for the medical team. The authors justify the patient's autonomy to request and to be granted a discharge. Then, present the decision-making process related to discharge for the reference of medical teams. Capacity is necessary to autonomy. There is currently no standard for assessing the capacity of patients that clearly defines their competence. A sliding scale approach to decision making distinguishes between decisions involving significant potential risk and, therefore, involving higher level of capacity requirements and decisions on minimal potential risk. In order to protect the interests of patients, the sliding scale approach takes into account different decisions. Cases in which schizophrenia patients choose to self-discharge involve a high-level of risk. Poor preparations for follow-up care lead to poor-quality patient care and may cause harm to the patients. In a share decision model, the medical team plays the role of negotiator between the patient and the family and respects the autonomy of the patient while supporting the family through the hospital discharge process. Medical team must have a discharge planning for the patient and family, follow-up care system, and support network. During hospitalization, the discharge plan aims to facilitate the life adaptation and disease recovery for patients with the goal of restoring their normal home life.
authors.affiliation: Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Taiwan, ROC.
authors.forename: Li-Yu
authors.initials: LY
authors.lastname: Chuang
authors.affiliation: Department of Nursing and Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Taiwan, ROC. meay@mail.ncku.edu.tw.
authors.forename: Mei-Chih
authors.initials: MC
authors.lastname: Huang
mesh_terms: D003657:Decision Making; D006801:Humans; D010351:Patient Discharge; D026684:Personal Autonomy; D012559:Schizophrenia / Q000628:therapy*
keywords: autonomy; capacity; schizophrenia; sliding-scale strategy