Top court stresses structured palliative care after withdrawal of treatment; warns DAMA should not be used to shift responsibility from hospitals
New Delhi: The Supreme Court of India has strongly criticised the routine hospital practice of discharging patients under “Discharge Against Medical Advice” (DAMA) when treatment is discontinued, warning that such actions may compromise patient care and shift responsibility away from doctors and healthcare institutions.
The court observed that DAMA forms are frequently 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 no longer be possible.
Court’s Observations During Passive Euthanasia Ruling
The remarks were made while the top court delivered a significant ruling allowing passive euthanasia for a 32-year-old man who has remained in a permanent vegetative state for more than a decade.
The bench clarified that even when treatment is legally withdrawn, doctors and hospitals must ensure that the patient is not abandoned and that proper medical care continues.
Bench Refers to 2018 Landmark Judgment
A bench comprising Justice JB Pardiwala and Justice KV Viswanathan referred to the guidelines laid down in the landmark Common Cause v. Union of India judgment.
According to the court, once a lawful decision is taken to withdraw or withhold life-sustaining treatment, the process must follow a structured, humane, and medically supervised 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 bench observed.
Shift Toward Palliative and End-of-Life Care
The court emphasised that when curative treatment is discontinued, it should lead to a transition toward a structured palliative care plan rather than ending medical supervision.
Such care should focus on:
- Pain relief
- Symptom management
- Ensuring dignity in the patient’s final stage of life
The bench noted that end-of-life care should remain medically supervised and compassionate, even after life-sustaining treatment is withdrawn.
Strong Disapproval of DAMA Practice
Expressing serious concern, the court said hospitals often misuse “Discharge Against Medical Advice”, also known 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 stated.
The court underlined that the exhaustion of curative treatment options should not mean the end of medical responsibility, and hospitals must continue to ensure proper care and support for patients in such critical conditions.
