HealthScapades Episode #20 | DAMA, the Damaging; DAMA, the Dangerous | 06.11.2024
by Tayo Fasuan
During the measles vaccination exercise of about two weeks ago, there were Adverse Events Following Immunisation (AEFI), which ranged from mild fever to a few rashes on some children. But they were successfully managed by both the parents and health workers/medical personnel.
However, there was a serious case that arose mainly from what is referred to as DAMA, discharge against medical advice, which, according to the name, is when a patient decides to leave the hospital without the consent of the treating physician.
In this particular case, a mother took her child away from where he was receiving treatment for AEFI and relocated him to another place. The condition of the child, who was suspected to be suffering from a previous ailment that wasn’t disclosed by the mother, has since worsened.
The attempt by the mother to pin the faults on health workers who vaccinated her child and the medical personnel who treated him has been rebuffed by the fact that she actually engaged in DAMA, discharging her child against several medical advisories.
Over the years, DAMA has posed serious clinical, ethical, and legal challenges to the individual physicians, healthcare facilities, and mostly children, who are the victims because most of the time they are not the ones making the decision and may not understand or contribute to it.
Of course, most DAMA cases are closely associated with parental poverty and ignorance, and in the case above, a bit of emotional blackmail when the case deteriorates. Leaving the hospital against the physician’s advice comes with risks and consequences that may be unbearable in the end.
The ethical dilemma associated with this issue looks pretty straightforward – a doctor intending to respect the patient’s wishes to leave against medical advice, due to the patient’s right to self-determination or autonomy, while also attempting to do what they think is best for the patient.
In practice, however, managing this issue is more complicated than simply dealing with the relevant ethical dilemma. Things that will come up in practical cases are physician-patient communication, informed consent, and even underlying psychiatric issues.
However, since neonates, little children under 5, and older children with #surgical conditions are the most vulnerable groups in most cases of DAMA, policies should be developed targeted at protecting these vulnerable groups. DAMA shouldn’t be allowed to be damaging anymore.