By Ryan Pferdehirt, D.Bioethics, HEC-C

February 2020

Patient is a 74-year-old male, suffering from COPD and ESRD. Patient requires oxygen and twice weekly dialysis. After a ten-day hospital admission, the attending physician has determined that the patient is medically cleared for discharge and recommends discharge to a SNF. The patient insists on being discharged to home, where his two children live with him and provide support. The patient says that they will help him make his dialysis appointments, as he is now wheelchair dependent, although this had not been true in the past. The medical team strongly suspects that the children living at home are active drug users and are likely to neglect the patient and not help him make his appointments. The team recommends him going to a SNF instead, which specializes in the dialysis required by the patient. The cost would be easily manageable. The patient says that he understands and appreciates their recommendation but insists that he does not care and will be going home.

The medical team requests an ethics consult.