Dan, a young man of 55, has been recently admitted to the emergency ward of a large urban hospital after suffering a fall that damaged his ear, broke his arm and may have caused internal bleeding in his brain. He is currently being treated for metastatic cancer (originally bladder - now brain). He had recently undergone brain surgery to remove a tumor to his cerebellum. He currently suffers from dramatic loss of motor skills. He fell trying to walk in his own in his apartment. He is unusually paranoid from large doses of steroids - and his brain has been compromised by recent intensive radiation therapy. He has a difficult time communicating due to loss of motor & mental skills. The hospital wants to keep him under surveillance for a couple of days - until they can schedule him for an operation on his ear. They are concerned about possible internal bleeding in his brain.

Dan wants to go home. He doesn't like staying in the hospital. He says, "I can't sleep here - they're not going to take good care of me."  When his partner who is exhausted from caring for him for the past six months says - "how are we going to take care of you in your current state?"

Dan responds, "You'll do fine." John responds that he can't do what's require now without a home health aid to assist them. Dan's response is, "I don't want a home health aid in our apartment." Dan asks to be discharged and begins formal motions to do so. His physician tells him that he would have to check out against medical advice - meaning that the hospital thinks it is dangerous for him to leave. 

Even after visiting with a social worker, Dan still wants to check out against medical advice. What should the hospital staff do? What should they take into consideration in making their decision?

Some suggested questions to consider in your posting:

• If you were to look at this as a consequentialist what are some things you would take into account to determine various harm/benefit ratios or calculations? In other words - what are various options we have and what are the consequences (good/bad) of them?
• If you were looking at this as a deontologist, what are some of the different obligations that are present in this case?
• Although we haven't explored bioethical principles yet, can you identify the relevance of one or more of these principles - respect for autonomy, beneficence, nonmaleficence, justice, virtue?
• How do we decide which options (consequentialist perspective) or which obligations (obligation perspective) should be weighted more and why? In other words - if there are several options and/or several competing obligations, how do we decide which are most important?
• What do you think ought to be done in this case?