Case Bank

Terminal Discharge

Mr N was diagnosed with cancer last year and treated with chemotherapy. He was diagnosed with brain metastasis on this admission. Mr N spoke to several nurses and said he wanted to stay in hospital. He did not want to burden his relatives at home because they were busy working. When the nurses asked him if he had shared his views with his relatives he said he found this difficult. His condition deteriorated rapidly over the next few days and he lost capacity to make his own healthcare decisions. Mr N’s wife told the doctors that Mr N wished to die at home and observe Buddhist rites upon death. These rites, which include 8 hours of chanting and an 8 hour no-touch rule, would be difficult to undertake in a hospital. N’s brother and wife offered to be his caregivers. The medical social worker advised that the family were not financially stable, were struggling to pay Mr N’s hospital bills and cannot afford inpatient hospice. She was also concerned about the level of care the caregivers could provide given they were employed full-time. Furthermore, the care team were concerned about the caregivers’ ability to correctly administer the necessary medications and manage Mr N’s nasogastric tube.

This case was originally designed for the 2016 CENTRES clinical ethics conference.

Questions for Discussion

  1. Is Terminal Discharge ethically different to other forms of home discharge?
  2. What is the standard of care required of healthcare professionals when terminally discharging patients?
  3. What other ethical issues does this case raise?