title: Ethical issues in mobile psychiatric treatment with homebound elderly patients: the Psychogeriatric Assessment and Treatment in City Housing experience.
abstract: Unique and challenging ethical difficulties arise during mobile psychiatric treatment of elderly patients. This article outlines and analyzes five of these challenges that have been encountered during nearly 20 years of experience with the Psychogeriatric Assessment and Treatment in City Housing Program in Baltimore, Maryland. The ethical challenges reviewed are: establishing the treatment contract versus the right to refuse treatment, protecting confidentiality versus patient protection, protecting autonomy versus asserting beneficence, treatment termination versus open-ended treatment, and cost versus benefit of care. Ethical challenges with homebound elderly patients are unique because of patient characteristics as well as features of the treatment environment.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Phoebe R. Berman Bioethics Institute, Johns Hopkins Hospital, 60 North Wolfe Street, Baltimore, MD 21287, USA. dmblass@jhmi.edu
authors.forename: David M
authors.initials: DM
authors.lastname: Blass
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Rye
authors.forename: Beatrice M
authors.initials: BM
authors.lastname: Robbins
authors.forename: Mary M
authors.initials: MM
authors.lastname: Miner
authors.forename: Sharon
authors.initials: S
authors.lastname: Handel
authors.forename: John L
authors.initials: JL
authors.lastname: Carroll
authors.forename: Peter V
authors.initials: PV
authors.lastname: Rabins
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015142:Baltimore; D015331:Cohort Studies; D015577:Geriatric Assessment; D006299:Health Services for the Aged / Q000941:ethics*; D006699:Home Care Services / Q000941:ethics*; D018577:Homebound Persons; D006801:Humans; D008605:Mental Health Services / Q000941:ethics*; D008952:Mobile Health Units / Q000941:ethics*; D017063:Outcome Assessment, Health Care; D011638:Public Housing