Ethical Hospital Discharge: A Balanced Algorithmic Approach

Hospital discharge decisions are often complex and multifaceted, bringing fundamental bioethics principles of beneficence, nonmaleficence, wise resource allocation and autonomy into tension. Balancing these principles effectively in complex clinical contexts can be a challenge for multiple reasons,...

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Published inThe journal of hospital ethics Vol. 7; no. 3; pp. 104 - 111
Main Authors Carey, Magalie, Stedman, Eleanor, Bruzzese, Cindy, Giglio, Cristel, Eldakar-Hein, Shaden T, Lahey, Tim
Format Journal Article
LanguageEnglish
Published Washington MedStar Washington Hospital Center 01.07.2021
Subjects
Decision making
Discharge
Discharge planning
Medical ethics
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Summary:Hospital discharge decisions are often complex and multifaceted, bringing fundamental bioethics principles of beneficence, nonmaleficence, wise resource allocation and autonomy into tension. Balancing these principles effectively in complex clinical contexts can be a challenge for multiple reasons, including clinician tendency to overemphasize beneficence toward individual patients, intrinsic lack of clarity of the commonly used concept of a "safe discharge" and complex social determinants of postdischarge options for patients. To alleviate these challenges, and thus provide clinicians with more workable ethical framework to use when considering hospital discharge, we discuss ethical tensions in hospital discharge decisions and propose a pragmatic hospital discharge decision-making algorithm which can help resolve moments of tension between competing ethical principles. This algorithm and regular multidisciplinary care meetings can ease caregiver conflict around discharge decision making and optimize discharge decisions for individual patients while supporting wise use of finite hospital resources.
ISSN:1938-4955
1938-4920