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Against medical advice


Against Medical Advice, or AMA, sometimes known as DAMA, Discharge Against Medical Advice, is a term used in health care institutions when a patient leaves a hospital against the advice of their doctor. While leaving before a medically specified endpoint may not promote the patient's health above their other values, there is widespread ethical and legal consensus that competent patients (or their authorized surrogates) are entitled to decline recommended treatment.

The available data suggests that in general, patients discharged AMA have an increased risk of hospital readmission, and potentially death. This data however, describes groups of patients discharged AMA, and therefore should not necessarily be applied to an individual patient wishing to leave AMA, and who may have different clinical circumstances and risks.

Although common hospital practice for an AMA discharge involves the patient being asked to sign a form stating that he or she is aware that they are leaving the facility AMA, the hospital is generally not legally required to use it. Rather, the legal and ethical requirement is that the authorized health care professional has an informed consent discussion with the patient regarding his/her choice to leave the hospital before it has been recommended. This discussion which includes disclosure of the risks, benefits, and alternatives to hospitalization, as well as the patient's understanding, should be documented in the patient's chart. Many physicians incorrectly believe that insurance denies payment for hospitalization for patients leaving AMA, leaving patients financial responsible. This "pervasive 'medical urban legend'” may lead to ethical problems, as it "scare[s] patients with misleading information" about their exposure to costs, leading to a "breakdown in the patient–doctor relationship" and an infringement of patient autonomy.

Some authors have begun to question the wisdom of the practice of designating a discharge as AMA, as it doesn't follow professional standards, lacks evidence of its utility to improve patient care, and may harm patients by reducing their likelihood of following up. Finally, there is widespread ethical consensus that even when patients decline recommended treatment, health care professionals still have a duty to care for and support patients.


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