The Sign-out Letter: Civil Right and/or Therapeutic Issue

Abstract

Sixteen consecutive hospitalized psychiatric patients who submitted “sign-out letters” were examined by an impartial psychiatrist in an attempt to discern the motivation/or the sign-out letter. In addition, the treating physicians and staff were also examined by the same impartial observer. We found that the use of the sign-out letter was determined more by unidentified and unresolved therapeutic issues than by primary concerns with civil rights. On the other hand, the sign-out letter can clearly be viewed as a statement of civil rights if the civil rights issue is understood to refer to patients’ right to refuse treatment if he or she feels the treatment is inadequate or injurious. A therapeutic approach to problems posed by the sign-out letters is suggested.