title: The patient who could not be discharged. How far should patient autonomy extend?
abstract: A male patient was admitted to the acquired immune deficiency syndrome (AIDS) unit for hemodialysis. His history revealed that he was homeless and that he had tested positive for human immunodeficiency virus (HIV+). He also had a history of alcohol and intravenous drug abuse and tuberculosis. Based on the results of a chest X-ray, he was placed in respiratory isolation. During the next few days of his hospitalization, he exhibited nonadherent behavior toward the treatment regime. Because of previous verbal and physical abuse to staff and patients, all local hemodialysis centers refused to accept him as a patient. Thus, he became a patient who seemingly could never be discharged. A discussion related to the theoretical and practical scope of patient autonomy, institutional altruism vs. institutional self-interest, and the need for social policy to facilitate a just and humane resolution to this ethical situation is presented here.
authors.affiliation: Rush University College of Nursing, Chicago, Illinois, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Bosek
authors.forename: L A
authors.initials: LA
authors.lastname: Burton
authors.forename: T A
authors.initials: TA
authors.lastname: Savage
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000188:drug therapy / Q000523:psychology*; D000328:Adult; D000437:Alcoholism / Q000150:complications; D001294:Attitude to Health; D026689:Ethical Analysis; D017041:Ethics Committees; D033061:Ethics Consultation; D004991:Ethics, Institutional; D004992:Ethics, Medical; D006703:Ill-Housed Persons / Q000523:psychology; D006801:Humans; D008297:Male; D010344:Patient Advocacy / Q000331:legislation & jurisprudence*; D010349:Patient Compliance; D010351:Patient Discharge / Q000331:legislation & jurisprudence*; D026684:Personal Autonomy; D016079:Refusal to Treat / Q000331:legislation & jurisprudence*; D006435:Renal Dialysis; D012945:Social Values; D015819:Substance Abuse, Intravenous / Q000150:complications; D016312:Treatment Refusal / Q000523:psychology*; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000188:drug therapy / Q000523:psychology*