Discharge Dilemmas: Patients with Disabilities

Consider someone leaving a hospital, after their care is completed at that location, to return to their home and local community. As discharge plans are made to continue their care, their healing, their rehabilitation, are there ethical challenges that arise? Can there be biases that shape that plan because of their ability, disability, lack of family support systems or resources available in the community? What are the frameworks, tools, approaches that an assist all involved? Our guests will offer their experience in these discharge plan dilemmas and offer the practical approaches they have utilized every day.

Joining us in conversation in this episode are:

• Debjani Mukherjee, trained as clinical psychologist and clinical ethicist, is Director of the Donnelley Ethics Program at the Shirley Ryan Ability Lab, Associate Professor of Physical Medicine and Rehabilitation and Medical Education at Northwestern University, Feinberg School of Medicine.
• Preya Tarsney, trained as a lawyer Bioethicist – Donnelley Ethics Program at the Shirley Ryan Ability Lab and a Lecturer of Physical Medicine & Rehabilitation at Northwestern University Feinberg School of Medicine and faculty lecturer at the University of Chicago, MacLean Center for Clinical Medical Ethics.
• Kristi L. Kirschner MD is a physician in physical medicine and rehabilitation and has practiced in this area for 30 years. She also has a background in clinical ethics and physical disability ethics and a faculty member of the university of Illinois College of Medicine where she directs the sub-theme of Humanities in Ethics for the College of Medicine.

Sessions are monitored on a monthly basis by CME office and content confirmed to be evidence based and without bias. Secondly, the CME Program Director and CME Coordinator reviewed and approved all material prior to the educational activity being approved to confirm that the educational activity was evidenced based. Peer reviewed journals and other literature are used, as applicable during discussions.

References for Further Study:

• Beware of Discharge: A Case Exploring the Ethics of Societal Expectations Placed on Families at Hospital Discharge
  Castro, A. R., & Tsimicalis, A. (2020). Beware of Discharge: A Case Exploring the Ethics of Societal Expectations Placed on Families at Hospital Discharge. Home Healthcare Now, 38(2), 98-104.
• Evaluation of an integrated model of discharge planning: achieving quality discharges in an efficient and ethical way
  Wells, D. L., LeClerc, C. M., Craig, D., Martin, D. K., & Marshall, V. W. (2016). Evaluation of an integrated model of discharge planning: achieving quality discharges in an efficient and ethical way. Canadian Journal of Nursing Research Archive, 34(3).
• Rehabilitation as “destination triage”: a critical examination of discharge planning
  Durocher, E., Gibson, B. E., & Rappolt, S. (2017). Rehabilitation as “destination triage”: a critical examination of discharge planning. Disability and rehabilitation, 39(13), 1271-1278.
• Thinking about the patient’s wishes: practical wisdom of discharge planning nurses in assisting surrogate decision‐making
  Kageyama, Y., & Asano, M. (2017). Thinking about the patient’s wishes: practical wisdom of discharge planning nurses in assisting surrogate decision‐making. Scandinavian journal of caring sciences, 31(4), 796-804.
• Schlairet, Maura C. “Complex hospital discharges: Justice considered.” HEC forum. Vol. 26. No. 1., 2014.

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