Supreme Court Ruling on DAMA: Hospitals Cannot Abandon Critical Patients

In a landmark medico-legal judgment that will fundamentally change how intensive care units operate across India, the Supreme Court has come down heavily on the routine hospital practice of issuing “Discharge Against Medical Advice” (DAMA) or “Leaving Against Medical Advice” (LAMA) forms to critical patients.

The Misuse of DAMA Forms

A division bench comprising Justices J.B. Pardiwala and K.V. Viswanathan observed that DAMA forms are frequently and inappropriately misused when patients are on life-support systems (such as ventilators) and families choose to take them home because doctors indicate that further curative treatment is futile.

The Court strictly noted that simply handing over a DAMA form and washing their hands of the situation risks amounting to an “abdication of medical responsibility.” The bench stressed that the end of curative care should never mean the end of medical responsibility toward the patient.

From Abandonment to End-of-Life (EOL) Care

Clarifying the passive euthanasia guidelines originally laid down in the 2018 Common Cause verdict, the Supreme Court ruled that withdrawing or withholding life-sustaining treatment must never result in the abandonment of the patient.

Instead of a sudden, unstructured DAMA discharge, the decision to stop curative care must immediately trigger a transition to a “carefully structured and medically supervised palliative and end-of-life (EOL) care plan.”

What This Means for Hospitals and Doctors

The bench mandated that even when a family decides to take a terminal patient home, doctors maintain a continuing duty of care. A proper EOL plan focusing heavily on pain relief, symptom control, and preserving the patient’s dignity must be prescribed at the time of discharge. This ensures the patient is not deprived of structured medical support during their most vulnerable and final phase of life.