Tuberculosis in AIDS patients: an ethical dilemma for discharge planning

Discharge planning with AIDS patients has become more complex since the resurgence of tuberculosis in this group. Such psychosocial problems as drug use, homelessness, and poverty have also contributed to the difficulty in discharge planning because of issues of noncompliance with medical regimens and the subsequent development of drug-resistant strains of TB. Ethical conflicts, resulting from balancing respect for patient autonomy with the obligation to cause no harm to society, arise for the health care professional who coordinates the discharge plan. Every effort to decrease the incidence of rehospitalization, especially through the emergency department, should be taken to control the cost of inpatient care. These efforts should focus on arranging for directly observed therapy and placing the homeless in shelters that promote outpatient treatment.