Financial Decision-Making Capacity and Patient-Centered Discharge

 

Annette Mendola

 

ABSTRACT

An ethically sound discharge from the hospital can be impeded by a number of factors, including a lack of payor for a patientís care, a lack of appropriate discharge options, and a lack of authority to sign a patient into a long-term facility. In some cases, the primary barrier involves the patientís lack of financial decision-making capacity.

            When a patientís income comes primarily from government assistance, financial decision making is connected to both the individualís well-being and to fair allocation of resources. Taking away another personís financial independence is a substantial intrusion on autonomy and should not be considered lightly. However, poor management of funds can lead to homelessness, medical noncompliance, vulnerability to financial exploitation, and other threats to human flourishing. As with medical decision-making capacity, poor decisions alone do not invalidate an individualís right to self-determination. And as with medical decision-making capacity, such determinations should not be made ad hoc or be capricious, but should rely on sound assessment criteria.  When there are justified concerns that a patient may be vulnerable due to limited financial decision-making capacity, an evaluation should be completed and a surrogate payee be sought, when appropriate.

 

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