King’s College London Student Clinical Ethics Committee case discussion: An elderly patient wants to go home following inpatient treatment,but it is thought she may be at risk in her own home and her discharge is delayed

Abstract

The Student Clinical Ethics Committee considered the case of an elderly woman who remained in hospital for 2 months after treatment, despite being considered medically fit for discharge, causing her great distress. The committee considered the justifications for keeping the patient on the ward in order to determine whether she was fit to be discharged to her home. The case study summarises the reflections of the committee and focuses on the capacity of the patient to make the decision to go home, the potential risks and consequences of discharging her, the concerns of the health care teams and their responsibility to make a decision.

Keywords

Discharge capacity aged care for specific groups clinical ethics resource allocation

Get full access to this article

View all access options for this article.

References

Delirium, or acute confusional state, is characterised by acute onset, a fluctuating course, inattention, disorganised thinking and an altered level of consciousness. Delirium is common and usually temporary and treatment involves investigating and managing the possible underlying causes. It is possible for patients to be considered fit for discharge with a diagnosis of delirium since the delirium may resolve once the patient is in familiar surroundings.

NICE Clinical Guideline 103, Delirium: Prevention, diagnosis and management, July 2010.

Law Commission, Mental Incapacity Report 231 HMSO, London 1995, para 3.41.

Mental Capacity Act 2005 s 4(4) – ‘the decision maker must, so far as reasonably practicable, permit and encourage the patient to participate, or to improve his ability to participate, as fully as possible in any act done for him and any decision affecting him.’.

Care Act 2014.

Social Care Institute for Excellence. Self-neglect Policy and Practice: Key Research Messages. London, 2015.

The patient appears to be deprived of her liberty in hospital in that she is subject to continuous supervision and control and she is not free to leave. Deprivation of Liberty Safeguards may need to be instigated if she lacks capacity to consent to the arrangements made for her care or treatment. If she has capacity then she should be enabled to leave. Deprivation of Liberty Safeguards, Social Care Institute for Excellence, 2015, http://www.scie.org.uk/publications/ataglance/ataglance43.asp (accessed 16 December 2015).