Discharge Against Medical Advice in Enugu, South Eastern Nigeria – Some Ethical and Legal Aspects

Abstract

Background: In exercising freedom to determine their own future without external restraints, patients admitted to hospital sometimes opt to leave against medical advice. This retrospective study was designed to determine the incidence of discharge against medical advice among medical patients and to highlight procedural pitfalls in its handling at the University of Nigeria Teaching Hospital Enugu Nigeria. Methods: Case notes of all medical patients who left hospital against medical advice in the medical wards of the University of Nigeria Teaching Hospital over a period of 4 years and 6 months were examined and information relating to patient\'s age, gender, diagnosis, duration of stay and reasons for leaving the hospital against medical advice extracted. Results: One hundred and fifteen medical patients left hospital against medical advice (82 males and 33 females) and 92 of them (80%) were admitted through the accidents and emergency department of the hospital. The discharge forms were signed by the patients\' relatives in 72 cases (64.3%) and by the patients concerned in 27 cases (23.5%). The reason for leaving against medical advice was not stated in 98 cases (85.2%). Neurological lesions (31.3%) and gastrointestinal/hepatobiliary diseases (27.1%) topped the list of working diagnoses. Most of the patients (62.6%) left within the first week of admission. No follow-up arrangement was made for any of the patients. Conclusion: Discharge against medical advice is frequent among medical patients especially those admitted as emergencies. The procedure adopted by medical staff in dealing with this very sensitive medical issue with high potential for serious ethical and legal breaches needs radical reforms

Keywords: Discharge against medical advice .

Journal of College of Medicine Vol. 13 (1) 2008: pp. 34-38