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

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.