Discharge against Medical Advice: Ethical and Legal Considerations (original) (raw)
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Discharge against medical advice Ethico-legal implications from
Background. Discharge against medical advice (DAMA) is a problematic issue for physicians worldwide, which can disrupt the physicianpatient relationship, have adverse medical outcomes and increase healthcare costs. This review aims to highlight the ethical and legal aspects of the issue from the perspective of developing countries in Africa, and make suggestions for resolving them. Methods. A comprehensive literature review of articles relating to DAMA was performed using databases such as PubMed, Medline and Google Scholar. The search criteria used were ‘discharge against medical advice AND ethics*’, ‘discharge against medical advice AND Africa’, ‘leaving against medical advice’, ‘discharge against medical advice AND legal issues’ and ‘self-discharge’. Relevant articles published from 1980 till 31 December 2011 were included. Results. The conflict between the professional values (benefcence) of the physician and the autonomy (self-determination) of the patient is the most prominent ethical dilemma in cases of DAMA. The issue of DAMA is more complicated in developing countries, especially because of communal models of decision making. One important ethical dilemma is the rationing of hospital admissions, especially for chronic conditions with poor prognosis. We have suggested a communal model for dealing with the issues. The main legal issue found in this review is the possibility of medical doctors being sued for medical malpractice. Conclusion. DAMA is associated with numerous ethical and legal issues of which physicians need to take cognizance.
Evaluation of Administration of Discharge against Medical Advice: Ethico‑legal Considerations
Background: Discharge against medical advice (DAMA) portends serious ethico‑legal consequences for healthcare givers. Several studies have described its prevalence and pattern but hardly any to evaluate adherence to standards by medical staff while administering DAMA in developing countries. Objectives: The objective of this study is to evaluate adherence of medical staff to standard protocols during the administration of DAMA in a public secondary hospital in Ondo State. Methodology: In a descriptive, retrospective study we examined case files and DAMA forms of in‑patients who obtained DAMA between April 2014 and September 2015 for design, signatories and completeness. Data were analysed by means of SPSS version 17. Results: A total of 235 patients (male:female, 1.03:1) who obtained DAMA out of 7465 in‑patients were studied. Their mean age was 40.5 ± 19.3 years (range, 17–110 years). The overall hospital DAMA prevalence was 3.2%. DAMA forms were inadequately designed, deficient and not protective against litigation. Improper processing of DAMA was high (66.7%). The only signatories in the DAMA forms were the nurses (8.5%) and patients' relatives (100%). There was no physician entry in the forms. Conclusions: Adherence to standard DAMA protocol by medical staff was poor. Update courses on ethico‑legal matters, adopting a discharge planning team, upgrading of DAMA forms and stressing global best practices will reduce or eliminate risk of litigations.
Physician Practices in Against Medical Advice Discharges
Journal for Healthcare Quality, 2019
Background: Patients discharged against medical advice (AMA) have disproportionately high health care costs and increased morbidity, mortality, and hospital readmissions. Although patient risk factors for discharge AMA are known, there are little data regarding physician discharge practices surrounding AMA discharges. Methods: We performed a cross-sectional analysis of patients discharged AMA from a large, urban, academic medical center. Our study predictors included patient demographics and admission characteristics: primary service team, time of discharge, documentation of anticipated AMA discharge, and length of stay. The primary outcomes were physician discharge practices including a scheduled follow-up appointment, documentation of informed consent, documentation of a risk/benefit discussion, and notification of the attending physician. Our coprimary outcome was the incidence of 30-day hospital readmission. Results: Among AMA discharges, 33% had follow-up appointments scheduled upon discharge. There was documentation of a risk/ benefit discussion (69%), informed consent (63%), and notification of the attending physician (72%) in most discharges. Physician discharge practices were not associated with 30-day hospital readmission. Conclusions: Adherence to discharge best practices in AMA discharges was inconsistent and suboptimal, particularly for scheduling follow-up appointments, but was not associated with hospital readmission. Our results highlight the difficulty in facilitating safe transitions of care for patients discharged AMA.
Discharge Against Medical Advice in Teaching Hospitals: A Telephone Survey
Background: Discharge with personal consent is considered as one of the main problems in hospitalization condition since many patients leave the hospital prematurely against the doctor’s advice. Thus, the aim of this study was to identify the factors affecting the discharge with personal satisfaction in selected teaching hospitals of Tehran University of Medical Sciences. Methods: The present study was a descriptive and cross-sectional analysis that was carried out on patients discharged with personal satisfaction from selected training hospitals of the Tehran University of Medical Sciences in 2016. The sample size was 153 patients who were randomly selected from Sina, Shariati and specialized women hospitals. The data were collected through using a self-made checklist and telephone interview. The SPSS V. 18 software and statistical tests such as Chi-square and t-test were used for data analysis. Results: The most common causes of patient’s discharge with personal satisfaction was personal issues related to the sick and the highest among these causes was patient recovery. The least common causes of discharge with personal satisfaction was related to the hospital. There was no significant link of gender, age, place and insurance type with personal discharge, but there was a significant link between the discharges of the hospital with own agreement and type of the hospital (P < 0.05). Conclusion: Hospital staff education, motivating the staff to participate actively in obtaining consent from patients and informing the patients about the stage of their treatment and recovery should be considered as priority management activities.
Reasons for Discharge against Medical Advice: A Case Study of Emergency
2013
Background: Incomplete hospitalization is the cause of disease relapse, readmission, and increase in medical costs. Discharge Against Medical Advice (DAMA) in emergency department (ED) is critical for hospitals. This paper aims to explore the underlying reasons behind DAMA in ED of four teaching hospitals in Kerman, Iran. Methods: This was a cross-sectional study in which the samples were drawn from the patients who chose to leave against medical advice from the ED of teaching hospitals in Kerman from February to March 2011. The sampling was based on census. Data were gathered by a self-constructed questionnaire. The reasons for DAMA were divided into three parts: reasons related to patient, medical staff, and hospital environment. The questionnaire was filled out by a face-to-face interview with patient or a reliable companion. Results: There were 121 cases (5.6%) of DAMA out of the total admissions. The main reason of AMA discharges was related to patient factors in 43.9% of cases...
Discharge against Medical Advice: A Case Study in a Public Teaching Hospital in Tehran, Iran in 2012
Global Journal of Health Science, 2013
Discharging against medical advice is to leave the hospital despite the advice of the doctor, which can result in complications and readmissions. This study aimed to examine the prevalence of patients' discharge against medical advice (DAMA) and their reasons in a public teaching hospital in Tehran, Iran in 2012. This was an applied and cross-sectional study in which all patients (2601 patients) who had been discharged against medical advice from the studied hospital in 2012 were studied. Required data were collected using a data collection form. Collected data were analyzed using SPSS 18.0 and descriptive and analytical tests including Frequencies and Fisher's Exact Test. The most and least common reasons for DAMA were, respectively, feeling complete recovery by patients (45.4%) and financial problems (1.3%). The results showed that there were significant differences between DAMA prevalence and patients' sex and age (P<0.001). The prevalence of DAMA in the studied hospital was high and according to the existence of social work units in every hospital, it is recommended that patients' consultation with the hospital social workers should be considered as an obligatory stage of the discharge against medical advice process in order to inform patients about its complications and adverse consequences.
To be or not to be discharged: an ethical dilemma
Psychiatric Bulletin, 1996
We describe the problems encountered in dealing with a 'discharge refuser' in the context of recent government guidelines on good practice In the discharge of mentally disordered people.
Qualitative health research, 2018
In this article, we present the experiences of discharging against medical advice from the perspectives of 17 hospital and community-based health care practitioners, and 16 patients, and relatives from a range of medical and surgical wards. Semistructured, in-depth interviews were conducted and thematically analyzed. We identified that practitioners, patients, and relatives frequently expressed empathy for each other during the interviews, and discharge against medical advice was presented as a way for patients to have control over their health. Contrary to predominantly negative framings that highlight increased mortality and morbidity, and portray people who discharge against medical advice as poor decision makers, we conclude discharge against medical advice can be framed positively. It can be an opportunity to empathize, empower, and care. We recommend that the vocabulary used in hospital discharge against medical advice policies and documents should be updated to reflect a cult...
Characteristics and outcomes of discharges against medical advice among hospitalised patients
Internal Medicine Journal, 2013
BackgroundDischarge against medical advice (DAMA) occurs when an in‐patient chooses to leave the hospital before discharge is recommended by the treating clinicians. The long‐term outcomes of patients who DAMA are not well documented.AimThe objective of this long‐term and hospital‐wide study is to examine characteristics of patients who DAMA, their rates of readmission and mortality after self‐discharge.MethodsAdministrative data of admissions to Flinders Medical Centre between July 2002 and June 2011 were used to compare readmissions and mortality among patients who DAMA with those who did not. The outcomes were adjusted for age, gender, emergency admission status, comorbidity, mental health diagnoses, and alcohol and substance abuse.ResultsIn the study period, 1562 episodes (1.3%) of 121 986 admissions to Flinders Medical Centre were DAMA. Compared with those who did not leave against medical advice, these patients were younger, more often male, more likely of indigenous ethnicity...