COVID-19 has made everything more difficult. In the clinical setting, it has made complex discharges from the hospital even more challenging. It has also shined a harsher light on systemic racism. This month’s Pediatrics Ethics Rounds (10.1542/peds.2021-055558) examines a patient discharge in which COVID-19 and systemic racism intersect.
Teresa is a Black adult with ataxia-telangiectasia who continues to receive her care at a children’s hospital. She was admitted following multiple hemorrhagic strokes and, while her health has worsened substantially, she is now ready for discharge. Her home health agency, however, is concerned that her and her mother Sarah’s apartment is longer adequate, and the medical team recommends discharge to a skilled nursing facility. At a point in the pandemic when such facilities were not permitting visitors, Sarah rejects this recommendation concerned that Teresa will be neglected, especially if she is unable to directly supervise Teresa’s care.
The commentators consider the relative risks and benefits of discharging Teresa home or to a skilled nursing facility and conclude that discharging her home is ethically acceptable even given the potential risks. One of the commentators, ethicist and pediatrician Dr. John Lantos, also highlights the effects of systemic racism on this case. Sarah and Teresa’s poor housing situation is likely to be due, in part, to the history of redlining. Dr. Lantos states that Sarah’s anger is justified and recommends the medical team acknowledge the unfairness she is experiencing. The case also raises the larger issue of hospitals and health systems’ obligation to dismantle systemic racism. Some, for example, have established medical-legal partnerships which help patients and their families, among other things, enforce their tenant rights.
As the pandemic persists, we must continue to address its negative effects and work to eliminate systemic racism. What would you do if you were discharging Teresa? What are you and your organizations doing to dismantle systemic racism?