Ensure patients are not abandoned: SC criticises hospitals over discharge against medical advice
Supreme Court of India
New Delhi: The Supreme Court has strongly criticised the routine hospital practice of discharging patients “against medical advice” (DAMA) when treatment is discontinued, cautioning that such actions may compromise patient care and shift responsibility away from treating doctors and healthcare institutions.
The court observed that DAMA forms are often issued in cases where patients are on life-support systems, such as ventilators, and families choose to take them home after doctors indicate that further curative treatment may not be possible. These remarks came while the court delivered a significant ruling allowing passive euthanasia for a 32-year-old man who has remained in a permanent vegetative state for over a decade.
According to a report by Hindustan Times, the court made these observations while outlining the legal and medical framework governing withdrawal of life-sustaining treatment. The bench emphasised that even when treatment is legally withdrawn, doctors and hospitals must ensure that patients are not abandoned and that appropriate medical care continues.
A bench comprising Justice JB Pardiwala and Justice KV Viswanathan referred to the guidelines laid down in the Supreme Court’s 2018 judgment in Common Cause v. Union of India and said that once a lawful decision is taken to withdraw or withhold treatment, the process must be handled through a structured and humane medical approach focused on 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.
The bench clarified that discontinuation of curative treatment should instead lead to a transition toward “a carefully structured and medically supervised palliative and end-of-life care plan.” Such care, the court noted, should prioritise pain relief, symptom control, and preserving the patient’s dignity in the final stage of life.
The court also 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.
The bench noted that hospitals sometimes resort to DAMA when curative treatment options are exhausted, but stressed that the end of curative care should not mean the end of medical responsibility toward the patient.
