Engage? Disengage? Discharge? Ethical approaches to fraught questions.

This article presents a framework to assist with the making of often challenging decisions about engagement and disengagement with patients across mental health services. The framework is based on Beauchamp & Childress's four principles of clinical ethics. We pose practical questions, illustrated by a clinical vignette, around these four principles in order to aid implementation of ethics-based decision-making. The framework is useful in both complex and seemingly straightforward issues. It can be used as a means of communicating what are often controversial decisions to fellow clinicians and patients.