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Ethics of managing acute illness in the home

Home management, using a hospital in the home team, is being shown to be an effective and safe management option when compared with the traditional inpatient management for a number of acute medical conditions. Are there any ethical considerations or objections? Bryant P (BMJ Open 2020;4:e000590; http://dx.doi.org/10.1136/bmjpo-2019-000590) has shown that healthcare providers who are familiar with acute home care believe this care follows the ethical tenets of autonomy, beneficence, non-maleficence and justice. Ethical dilemmas appear to arise when other people such as staff members and parents need to be considered. When home care was deemed inferior clinically to hospital care, it was felt to be least ethical. Bryant determined the views of healthcare professionals (eighty physicians, nurses and allied health staff who provide acute home care for children) on the ethics of providing home care. While the provision of acute home care was deemed ethical by the majority (77/80, 96%), this decreased when other factors were involved such as domestic violence (37/63 (59%) OR 0.06, 95% CI 0.02 to 0.20, p<0.001) and parental reluctance (28/67 (42%) OR 0.02, 95% CI 0.008 to 0.09, p<0.001). The age of consent affected the proportion …

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  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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