Discharge against Medical Advice and Transcending Boundaries in Ghanaian District Hospitals: Issues for Medical Learning

Kofi Tawiah Mensah

doi:10.21315/eimj2020.12.4.8

Abstract

There is a case of a 47-year-old man who presented to the Agogo Presbyterian Hospital with a highgrade intestinal obstruction. Although the surgical expertise was available, limitations of laboratory and critical care services at the time necessitated a referral to a tertiary hospital. The patient and his relatives did not have the resources to pursue this treatment decision and opted for a discharge against medical advice (DAMA) to embark on faith-based treatment options. The attending clinician is sometimes frustrated in such complex scenarios by the inability to explore even the slightest survival chances that could result from life-saving surgery in the face of these resource limitations. This article focuses on the ethical and medicolegal dilemmas presented to clinicians by a patient’s request for DAMA. Some pragmatic approaches have been proposed to guide the evaluation and resolution of such challenges at the level of Ghanaian district hospitals for the benefit of medical learning.

Highlights

Discharge against medical advice (DAMA) is often happens in Ghanaian clinical settings and medical trainees should be well informed of the dynamics and dilemmas involved in managing such situations well in advance
As opposed to being granted a DAMA to resort to Faith-based healing (FBH), it could be better for critically ill surgical patients to “have a go” at surgery, the great risk sometimes, within the controlled environments of the hospital
DAMA will probably be an inherent part of clinical care in Ghana for which trainees would benefit from adequate exposure and preparation to deal with its multifaceted influences and consequences

Summary

INTRODUCTION

Discharge against medical advice (DAMA) is often happens in Ghanaian clinical settings and medical trainees should be well informed of the dynamics and dilemmas involved in managing such situations well in advance. On experiencing intermittent abdominal pains and constipation of increasing severity over the course of a month, that was associated with progressive distension not responding to herbal remedies, he reported to a nearby health centre He was referred to the closest district hospital for treatment. The laboratory could not run serum electrolytes to allow for objective assessment and correction of derangements in preparation for surgery His relatives could no longer come up with health care bill, and because he did not possess an active health insurance policy, they insisted on pursuing alternative treatment out of the hospital and produced a letter to that effect. Subsequent feedback after this separation, confirmed that he was taken home for the intended alternative medicine but died a few hours after arrival

Findings

DISCUSSION

CONCLUSION