SUMMARY OF CASE REVIEWED
BY THE ETHICS COMMITTEE
(January 21, 2013)
Case of Patient without Family and with HIV: Two hospice social workers presented the case of a patient with a recorded history of HIV disease, bipolar disorder and other medical issues. His hospice diagnosis is end stage HIV. He has no family, and upon admission into hospice was no longer able to adequately care for himself, as he was living alone. The case presenters requested that the ethics committee reflect on this case in light of questions of his autonomy and the pursuit of his “best interests” for end-of-life care and appropriate placement.
Discussion: It was noted that placement can be difficult for patients of his age (the 30s) and with his history of mental issues and HIV. State regulations require multiple and lengthy processes to be completed, before permitting a nursing home or facility to admit such a patient. This process is called PASRR (Preadmission Screening and Resident Review).
Outcomes: The ethics committee discussed the importance of advocating for this patient and for seeking appropriate placement, particularly because he has no one else to help him. In that regard, the ethics committee also spoke about the possibility of seeking guardianship to oversee his best interests and ongoing care. His social worker is going to follow up with placement and guardianship possibilities. The ethics committee praised the hospice personnel, who are treating the patient with respect and dignity, respecting his autonomy, seeking his best interests and pursuing resources and services for his care.