Supreme Court comes down heavily on discharging patients ‘against medical advice’

The Supreme Court said hospitals sometimes resort to such discharges when curative treatment is no longer possible

The Supreme Court on Wednesday came down heavily on the common hospital practice of discharging patients “against medical advice” when treatment is discontinued, warning that such a course risks undermining patient care and may amount to an abdication of medical responsibility.

The court passed a landmark judgment allowing passive euthanasia for a 32-year-old man. (ANI)

Such “discharge against medical advice” (DAMA) forms are frequently issued in situations where patients are on life support, such as ventilators, and their families seek to take them home after doctors indicate that further curative treatment is uncertain. The observations came in a landmark judgment allowing passive euthanasia for a 32-year-old man who has remained in a permanent vegetative state for more than a decade.

While elaborating the legal framework governing withdrawal of life-sustaining treatment, the court emphasised that the decision to stop medical intervention cannot result in abandonment of the patient.

A bench of justices JB Pardiwala and KV Viswanathan held that once a lawful decision is taken to withdraw or withhold medical treatment in accordance with the guidelines laid down in the Supreme Court’s 2018 ruling in Common Cause, the process must be carried out in a humane and structured manner through palliative and end-of-life care.

“The withdrawal or withholding of treatment must not, in effect or execution, result in the abandonment of the patient,” the court said. Instead, it added, the decision should mark a transition from curative medical intervention to “a carefully structured and medically supervised palliative and end-of-life care plan.”

Such a plan, the court said, must focus on alleviating pain and distress, managing symptoms, and preserving the patient’s dignity during the final stages of life. In this context, the court expressed strong disapproval of the routine hospital practice of issuing “discharge against medical advice”, also referred to as “leaving against medical advice” or “discharge at own risk”.

“We strongly disapprove of the routine practice of ‘discharge against medical advice’… which is misused in situations where medical treatment stands discontinued,” the judgment said.

According to the bench, hospitals sometimes resort to such discharges when curative treatment is no longer possible.