Structures of Safety in Hospital Disposition: Five Ethical Responsibilities

Complex hospital disposition is categorized by the difficulty or impossibility, despite efforts, to secure a medically safe discharge option for a patient. Discharge planning should negotiate limited inpatient resources that must be distributed justly, while also considering failures of outpatient and social resources to meet the patient's needs. This essay argues that recognition of these structural insufficiencies, which are inequitably distributed, must be a starting point for addressing safe hospital disposition. This recognition grounds five ethical responsibilities for navigating complex disposition planning: justice, common good, respect for persons, harm reduction, and care. Each responsibility is applied to common complex disposition vignettes, with attention to practical guidelines for implementation in clinical spaces.