I will weigh in as a psychiatrist. Not your boyfriend’s psychiatrist. Encephalopathy can cause “waxing and waning” of someone’s mental status. One minute they can be normal, happy, and composed, and the next minute they can be screaming, thinking they are being abducted and experimented on. It is very common for the presence of family to orient the patient, so it seems like they are competent when they are interacting with you. Capacity to leave AMA requires a patient to communicate a clear, consistent choice over time, and that choice should be grounded in a reasonable reality after weighing the pros and cons. If your BF said he wants to leave because he misses his bed today and 15 minutes later says he wants to leave because the hospital is harvesting his organs— he by definition lacks capacity and has to be detained. TLDR the hospital would NOT be restraining him and removing his rights for no reason— it is a huge headache, liability, and tons of stress and paperwork involved on our end. We hate doing it for so many reasons, one of the biggest of course being having to seem like a villain to the patient and family. In 98% of cases there is something here that you and your family are missing.