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Discharging to the Street: When Patients Refuse Medically Safer Options.

Georgina D Campelia1, James N Kirkpatrick2, Patsie D Treece3

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Homelessness complicates safe hospital discharge, leading to poor health outcomes and readmissions. This study examines the ethical challenges and responsibilities when discharging patients experiencing homelessness.

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Area of Science:

  • Medical Ethics
  • Public Health
  • Health Equity

Background:

  • Homelessness is a significant social determinant of health, negatively impacting patient outcomes and increasing hospital readmissions.
  • Clinicians face ethical dilemmas when patients experiencing homelessness decline safer discharge options, potentially leading to discharge to the street.
  • Inpatient resource allocation is strained when hospital beds are occupied by patients not requiring acute care.

Purpose of the Study:

  • To investigate the forms of injustice experienced by patients discharged to the street.
  • To map the ethical responsibilities of clinicians, hospitals, and skilled nursing facilities in managing discharges for patients experiencing homelessness.

Main Methods:

  • Qualitative analysis of ethical considerations in patient discharge.
  • Exploration of social determinants of health and their impact on clinical decision-making.
  • Review of institutional and societal factors influencing discharge planning.

Main Results:

  • Discharge to the street raises profound issues of nonmaleficence and social justice.
  • Clinicians' ethical obligations are challenged by resource limitations and patient autonomy.
  • Interconnected responsibilities exist among healthcare providers, institutions, and social services.

Conclusions:

  • Addressing the ethical complexities of discharging homeless patients requires a multi-faceted approach.
  • Healthcare systems must acknowledge and act upon their role in social justice.
  • Improved collaboration between hospitals, skilled nursing facilities, and social services is crucial for safe and ethical discharge planning.