Hospital Discharge of Frail Elderly People: Social and Ethical Considerations in the Discharge Decision-making Process

Abstract

ABSTRACTUsing contributions from moral philosophy and sociology, this paper explores the decisions confronting care professionals when discharging frail elderly people from hospital. It is based on research into hospital discharge in South Glamorgan that has illuminated the nature of professional decision-making in multi-disciplinary ward meetings. Two key dilemmas are identified and examined in detail: first, the dilemma of discharging elderly people who, while thought by professionals to be incapable of looking after themselves and therefore ‘at risk’, nevertheless want to go home, and secondly, the dilemma of finding residential care for elderly people who are defined as being ‘partly sick and partly well’. Whilst the principle of autonomy may be used to support individual choice, it may also be interpreted as encouraging self-reliance, and as a way of denying a collective responsibility to elderly people's care needs. The dilemma of institutional care for the ‘partly sick and partly well’ is found to be a persisting problem, fraught with conceptual ambiguities and resource-boundary negotiations between ‘medical’ and ‘social’ care. An examination of both dilemmas serves to highlight the role of political ideology in discharge decisionmaking.