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In Reply: I completely agree with Dr Bernheim and colleagues that the ethical dilemma described in the article only exists because of the patient's socioeconomic status. Although not included in the article, the original Grand Rounds presentation addressed the larger context of the systems of health financing and delivery as they relate to patients with financial and social resources similar to this patient.

I read with concern the account by Dr Quigley and colleagues about laws in England and Wales that allow for patients to be forcibly removed from their dwellings. I agree with their suggestion that in cases like Mrs A’s, having a meeting of all stakeholders sooner rather than later is advisable. As described in the article, a meeting like this occurred 8 months before Mrs A was hospitalized.

I agree with Dr Spiess and Ms Tomm that home hospice could have been considered in this case. Hospice . . . [Full Text of this Article]

Joseph Carrese, MD, MPH
jcarrese@jhmi.edu
Program on Ethics in Clinical Practice
Phoebe R. Berman Bioethics Institute
Johns Hopkins University School of Medicine
Baltimore, Md

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