Discharge against medical advice: Ethico-legal implications from an African perspective
AbstractBackground. 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 (beneficence) 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.