Abegail Jane L.

Jutba BSN 4B RLE

Group 2

A Complementary Reflection: Home Against Medical Advice

Home against medical advice (HAMA) or discharge againts medical

advice ( DAMA), wherein a patient chooses to go home even before his/her
doctor recommends his/her discharge from the medical facility. This
occurrences continues to be a common and vexing problem, especially to
patients who have decreased capability in keeping up with the financial
stress hospitalization that can incur. According to Alfandre (2009), between
1%-2% of medical admission results in HAMA and predictors of this
phenomenon are based primarily on retrospective cohort studies, tended to
be younger age, Medicaid or no insurance, male sex, and current or a history
of substance or alcohol abuse. Moreover, especially in the Philippine setting,
the number one cause or predictor of HAMA is poverty. In a Mayo Clinic
article it is said that those patients discharged as HAMA are at higher risk of
morbidity and morbidity. With higher risk of morbidity and mortality, those
patients who leave hospitals againts their physicians orders are also at
higher risk for readmissions, developing ugly outcomes and increase in
medical expences than those who follow what they are told.
It is aptly stated in the patient's Bill of Rights that the patient have the
right to refuse medical treatment. "Medical decisions are a partnership
between the patient and the doctor, but the patient is nearly always the final
decision maker," says Steven Stack, a member of the board of the American
Medical Association and an emergency room physician in Lexington,
Kentucky, in an article by Payne (2009). However as medical practitioners, do
we just let them go away we just those sentiments? This is a major ethical
delimma for the physician and the other members of the healthcare team.
According to Carrese (2006), there are two fundamental ethical obligations
that appear to be in conflict with patients requesting for HAMA: (1) the duty
to promote a patient's well-being and protect the patient from harm and (2)
the duty to respect the wishes of a competent patient . During an event of
HAMA everyone in the health care team are worried and concerned that the
patient's well-being would be compromised and threatened if he leaves still
not feeling well or not completing her hospitalization. At the same time, the
health care team is also bothered by the thought of contradicting the
patient's decision and maligning his/her rights just to promote her safety for
the sake of the patient's well-being. This is never easy for the medical team
to accept a patient's decision that depart from the recommended
confinement in the medical facility and course of action that should be
taken. This is very difficult to accept because its considered bad from a
medical perspective and its even irrational. However, how intangible this
situation might become we should still also apply some approach that would
make the patient reconsider his/her decisions or provide interventions and
teachings that will prevent any untoward incidents and complications that
may develop after the discharge.
Finally, we should always keep in mind as medical personnel, that the
patient's decision for his/her care is always the deciding factor for the
continuity of care he/she wished to receive. Even though its “bad” in the
view of the health care team we should still preserve her autunomy and at
the same time give him/ her optimal care management.