When I was on call earlier this week as a hospitalist, I talked with a single parent whose older child was admitted with an asthma exacerbation. Her younger child was with her and the social worker on call was unwilling to make an exception to our institution’s visitor policy that prohibits minor siblings from staying overnight. The younger child did not fit the existing exception of being a breastfed infant. The mother was distraught at the thought of leaving her son by himself but the only childcare available for her younger child was over an hour away.
This Ethics Rounds considers a similar case (10.1542/peds.2021-051254). The commentators, Elizabeth Lanphier, PhD, MS, and Luke Mosely, MD, MTS, emphasize that hospital policies and procedures may have different effects on different types of families. In this case, prohibiting minor siblings from staying overnight may affect two-parent households differently than single-parent ones. They contend that policies and procedures should be equitable. Part of the issue is whether exceptions should be made on an ad hoc basis or formulated as rules. For example, minor siblings are not permitted to stay overnight unless the parent is breastfeeding or is a single parent without access to childcare. Another part is determining when a sufficient accommodation has been made and the institution is justified in not making further accommodations.
I tried to reassure my patient’s mother that her older child was safe and that we would take good care of her older child if she was unable to say overnight due to her need to care for her younger child. I would have reconsidered if the patient expressed severe separation anxiety as she prepared to leave. Read the case and commentaries and consider whether I did the right thing.