Ethical Issues in Complex Discharge Cases

Abstract

Discharging a patient from a hospital has become fraught with challenges in recent years. Patients may refuse a discharge to an environment that is considered to meet appropriate safety standards or such a “safe discharge” may not be possible. Moreover, a patient’s legal status may preclude an appropriate discharge. Patients who are unrepresented by family or friends may not have an appropriate surrogate to make healthcare decisions as well as care for a patient once they have been discharged. A discharge becomes difficult when there is an issue concerning ongoing patient safety or financing of placement in an appropriate facility. Difficult discharges are more accurately labeled complex discharges, as they often require the input of a variety of stakeholders, or medically complex discharges because of the need for the receiving venue to be able to meet the continuing medical needs of the patient. This chapter will discuss relevant ethical issues with regard to complex discharges. Principles such as autonomy, beneficence, nonmaleficence, and justice will be discussed, as will relevant organizational ethics issues. Our institution’s response to complex discharges will also be addressed.