Friday, July 24, 2009

A shelter for intoxicated homeless -- a cause for ethics committees?

Rosemary Flanigan
July 24, 2009

Denise, an email correspondent, has thrown down a gauntlet.

To the question, “How can our ethics committees do something ‘practical?’” she says: Needed: a shelter (other than a hospital bed) for intoxicated homeless. And she buttresses her request with good ethical principles and sees it as a matter of distributive justice.

That set me to thinking: What if the ethics committee at Denise’s hospital were to send a request to all ethics committees in our city to garner support for such an idea? I can see the committee chairs calling on the VP for Mission Effectiveness or the Development office to see if funds were available.

But a lot of spade work would have to be done first—and that is the place where my own lack of imagination and ingenuity bogs down.

HELP!! How “practical” ought ethics committees to be?? Anyone who isn’t on vacation, help us out here!!!

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Blogger Practical Bioethics said...

From Linda Kerby:

This, as they say, is where the rubber meets the road.

It’s all very well and good to discuss an issue, and issue guidelines and standards, but of what value are those if they are not implemented and/or utilized?

I got in big trouble years ago in a women’s church group when the leader announced that we were going to “adopt” a family for the holiday season.

Turns out that the definition of adopt was “write a check”. At that time I was working as a public health nurse in Wyandotte County and I had access to families every day that would have benefitted from “adoption”, no matter what the definition.

Since this was a church group, I had the audacity to suggest that instead of throwing money their way that we consider preparing meals with them or for them, that we go shopping with them, or that we visit them in hospitals or nursing homes, tutor their school children or do something active to show our support.

It got very quiet in the room for about 30 seconds before the leader resumed the “discussion” as if I had never spoken.

I can tell you for sure, having worked at KU Hospital, Truman Medical Center, and Western Missouri Mental Health Center, that their census would decrease quickly and significantly if the shelter proposal were to be put into practice.

Of course, this kind of practice could lead to setting up Ronald McDonald houses and all sorts of other foolishness…

Linda L. Kerby
Mastery Educational Consultations
Leawood, Kansas

Friday, July 24, 2009  
Blogger Practical Bioethics said...

From Denise Mogg:

Emergency Departments treat physical and psychological illness daily for homeless patients. It is not a matter of "ER's dislike treating them" but rather a frustration of the gap between our care and readily available resources within the community, including the basics such as food and shelter.

One example out of many...we treated a homeless patient for an infection by administering ointment to his wound twice a day for weeks. He didn't require admission to the hospital for this care or we would have admitted him.

Instead, we kept the ointment at the nurse's station and every time he visited, we cleansed and treated the wound. The basic care was simple and we knew he would not attend to his wound so we did it.

I am certain other inner city facilities do the same every day.

I agree with you regarding the significant lack of available providers and facilities to properly treat mental illness. Without a doubt, countless people are falling through the cracks due to this issue.

Friday, July 24, 2009  
Blogger Practical Bioethics said...

From Terry Rosell:

From Terry Rosell

My clergy spouse was involved in the early stages of forming an Interfaith Hospitality Network here in Johnson County, KS. Our church is one of a couple dozen faith community sponsors. It fills a niche, though not completely.

What Denise suggests is something beyond what IHN could handle, presently.

I'm not sure that this falls within the responsibilities of hospital ethics committees, practically or theoretically. Yet it would seem to be the responsibility of some part of a civil society. Which? Who?

And what does civility require in response to those who suffer the disease of alcohol addiction, are acutely symptomatic, and also have no home or other safe place to be sick--or possibly recover?

Tarris Rosell, PhD, DMin
Program Associate, Center for Practical Bioethics
1111 Main St, Suite 500, Kansas City, MO 64105 (816.979.1361)

Professor--Ethics & Ministry Praxis, Central Baptist Theological Seminary
6601 Monticello Rd, Shawnee, KS 66226-3513 (913.667.5741)

Associate Professor--Ethics, KU Medical Center, School of Medicine
2025 Robinson Hall, MS #1025, 3901 Rainbow Blvd, Kansas City, KS 66160 (913.588.3066)
Mobile: 913.909.3863 Pager/Texting: 913.917.0152

Friday, July 24, 2009  
Blogger Practical Bioethics said...

From George Flanagan, DMin, MA:

Since I work in substance abuse treatment at the VA, I’m intrigued by the concept. In the VA, nationally, we see it as part of our commitment to veterans to help them find safe havens after they go through a treatment program; however, we tend to leave them on their own when they are drunk.

If they drink, they are out of the program or shelter; they must get sober and start the process today.
They cannot come into treatment until they are sober.

VA has an extensive Homeless Veterans program, but all shelters have a sobriety requirement. So, your query remains a relevant ethics inquiry. It is, indeed, a question of resources distribution.

I remember in the early 90s the remarks of a nurse in Medical Intensive Care. She was angry that an ICU bed was occupied by a patient with alcoholic ascites—“he inflicted this on himself—we have veterans who need this bed who didn’t self-inflict their illness.”

She clearly felt that alcoholics were at the bottom of the eligibility list. We are more evolved in the substance abuse community, but I still regularly encounter social workers and nurses who have no tolerance or mercy for alcoholics and drug addicts.

When a veteran is heavily intoxicated, sometimes to the point of immediate risk of life, we will admit the patient to the medical center for detoxification and stabilization, often followed by alcohol tx program (patient’s choice, sometimes our choice if they’re “frequent fliers”).

True, it often seems to be a revolving door and many healthcare professionals will question the expense—much more in the private sector.

But we regard it no differently than we do someone with an exacerbation of mania or depression or psychosis because he/she decided not to take their medications: We treat because they are ill.

Now, a community shelter for intoxicated homeless? To what end? One without any requirement of sobriety or commitment to recovery? For those who continue to drink daily as a way of existence and come looking for a “hot and a cot” every night?

It is an issue in your blog because your e-mailer knows that all the “street missions,” usually conservative evangelical Christians with a strong social conscience, only allow admittance to the sober—they are quite deontological in their work, and it is woven into their mission statements.

True, they have very limited resources, and true, they are committed to the complete salvation of the suffering. But I wonder if sometimes they still see drunkenness as a moral failure.

My personal Christian ethic leads me differently than the missioners: It is humane to care for others in spite of their condition or the source/cause of their affliction or “who” they are (just an old sot!).

That’s the point of Jesus’ story of the good Samaritan.

But, healthcare is outcomes based and limited in resources, so we feel driven to ask: What do we hope to achieve other than “hot and a cot“? How intoxicated? Too drunk to walk but not drunk enough to go to the emergency room?

(Actually, many homeless chronic alcoholics are quite ill, usually with liver disease, often complicated with Hepatitis, etc.)

Will it serve to reinforce and/or approve the behavior? A beneficent (and, perhaps, paternalistic) healthcare professional could not turn him/her out again in the morning attempting an intervention, sometimes with strings, to keep him/her alive.

For me, though, first, it’s a matter of hospitality.


Chaplain, Mental Health

Monday, July 27, 2009  

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