I'm not sure that turning toward the runway from downwind at LPMA is such a good idea, with the runway being so near the high ground.
With a good understanding of the obstacles, there's little doubt that a turn to sea is better. But I think the PAN-OPS principle still works -- there should be plenty of room for a right 270 degree turn at the circling MDA from any point right downwind.
The general principle is that the protected area is a circle(-ish) centred on the airport, thus turning towards the centre of that protected area is usually better than turning towards its edge.