Sixteen consecutive hospitalized psychiatric patients who submitted "sign-out letters" were examined by an impartial psychiatrist in an attempt to discern the motivation for the sign-out letter. [Sign-out letters are requests for discharge against medical advice, as permitted by the Mental Hygiene Law of New York State as of January 1973.] In addition, the treating physicians and staff were also examined by the same impartial observer. The authors 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 a patient's 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.