Schlairet Maura C
College of Nursing and Health Sciences, Valdosta State University, 1300 North Patterson St., Valdosta, GA, 31698, USA,
HEC Forum. 2014 Mar;26(1):69-78. doi: 10.1007/s10730-013-9220-6.
How do we respond to the patient who no longer needs inpatient care but refuses to leave the hospital? Complex hospital discharges commonly involve consideration of legal, financial, clinical, and practical issues. Yet, the ethical and contextual issues embedded in complex inpatient discharges are of concern and have not received adequate attention by medical ethicists. The aim of this work is to encourage clinicians and administrators to incorporate a justice rubric when approaching inpatient discharge dilemmas. This paper presents justice as the ethical principle most neglected in situations involving complex discharges and suggests that a justice focused lens allows clinicians and administrators to move beyond notions of patient autonomy in crafting morally responsible hospital discharge decisions that reflect efficient stewardship of an appropriate share of medically indicated services. This issue deserves additional attention from medical ethicists in the future.
对于不再需要住院治疗但拒绝出院的患者，我们该如何应对？复杂的医院出院事宜通常涉及对法律、财务、临床和实际问题的考量。然而，复杂的住院患者出院所蕴含的伦理和背景问题令人关注，却尚未得到医学伦理学家的充分重视。这项工作的目的是鼓励临床医生和管理人员在处理住院患者出院困境时纳入公正准则。本文提出，公正是在涉及复杂出院情况中最被忽视的伦理原则，并表明以公正为重点的视角能让临床医生和管理人员在做出符合道德责任的医院出院决策时，超越患者自主权的概念，这些决策应体现对适当份额的医疗指示服务进行有效管理。这个问题未来值得医学伦理学家给予更多关注。
