Disposition Decisions in Cases of Medical Complexity and Health Inequity

Title

Disposition Decisions in Cases of Medical Complexity and Health Inequity

Creator

Shapiro J P; Anspacher M; Madrigal V; Lantos JD

Publisher

Pediatrics

Date

2022

Subject

Adult; Covid-19; Child; Ethics; Clinical; Health; Inequities; Humans; Palliative Care; Pandemics

Description

The question of optimal disposition for children with complex medical and social circumstances has long challenged the well-intentioned clinician. The coronavirus disease 2019 pandemic created unique difficulties for patients, families, and health care providers, in addition to highlighting long-standing racial and socioeconomic inequities in health care. In pediatric hospitals, necessary public health measures such as visitor restrictions shifted many shared decision-making processes such as discharge planning from complicated to impossible. Here, we present the case of a medically complex adult (with a long-standing pediatric condition) whose surrogate decision-maker objected to discharge to a long-term care facility because of restrictions and risks associated with the coronavirus disease 2019 pandemic. We offer the commentary of experts in clinical ethics, intensive care, inpatient subacute care, and palliative care. Our discussion includes analysis of the ethical considerations involved in the case, concrete guidance on steps toward an ethically permissible discharge, and suggestions for how a health equity lens can improve communication and decision-making for families who are victims of systemic racism and economic discrimination.

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Citation List Month

October 2022 List

Collection

Citation

Shapiro J P; Anspacher M; Madrigal V; Lantos JD, “Disposition Decisions in Cases of Medical Complexity and Health Inequity,” Pediatric Palliative Care Library, accessed February 5, 2023, https://pedpalascnetlibrary.omeka.net/items/show/18387.

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