A Sticky Situation: Is this guy competent to sign out AMA?

46 y/o male presents w/ complaints of exertional chest pain. History of etoh abuse. Last drink 6 hours ago. Physical exam unremarkable. Database notable for non-specific EKG; otherwise unremarkable. Etoh level 150.

After waiting 3 hours for admission, patient wants to sign out AMA. Ok or not?

• Does the patient have adequate decision making capacity?


• If patient is permitted to "sober" and metabolize off the etoh he might go into w/ drawal. He certainly won't have adequate decision making capacity then.


• Hmmmm ... what to do?