Ethical Issues Raised by Patient Non-Adherence in the Homeless Population
DOI:
https://doi.org/10.47611/jsrhs.v13i3.7495Keywords:
Homeless, Patient Non-Adherence, Chronically Homeless, Healthcare System, Health insurance, Mental Illness, Systemic racism, Healthcare expenses, Patient outcomes, Ethical PrinciplesAbstract
This paper delves into the ethical complexities surrounding patient non-adherence within the homeless population, exploring its multifaceted causes and profound consequences. Homelessness, exacerbated by systemic issues and societal neglect, engenders unique barriers to healthcare access and medication adherence. Drawing on principles of justice, autonomy, and beneficence, this paper advocates for equitable treatment, respect for autonomy, and proactive measures to enhance well-being. By addressing the underlying systemic injustices and implementing targeted interventions, healthcare professionals, policymakers, and society at large can uplift the dignity and improve the outcomes of homeless individuals. However, addressing patient non-adherence is just one facet of the broader challenges faced by the homeless population, underscoring the imperative for comprehensive societal action and reform.
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Bonner, Adrian, and Claire Luscombe. “Suicide and Homelessness.” Journal of Public Mental Health, vol. 8, no. 3, 20 Nov. 2009, pp. 7–19, nhchc.org/wp-content/uploads/2019/08/suicide-fact-sheet.pdf, https://doi.org/10.1108/17465729200900016. Accessed 24 Apr. 2024.
Bureau, US Census. “Health Insurance Coverage in the United States: 2022.” Census.gov, 12 Sept. 2023, www.census.gov/library/publications/2023/demo/p60-281.html#:~:text=Highlights. Accessed 2 Mar. 2024.
Coe, Antoinette B., et al. “Medication Adherence Challenges among Patients Experiencing Homelessness in a Behavioral Health Clinic.” Research in Social & Administrative Pharmacy : RSAP, vol. 11, no. 3, 2015, pp. e110–e120, www.ncbi.nlm.nih.gov/pmc/articles/PMC3733792/, https://doi.org/10.1016/j.sapharm.2012.11.004. Accessed 24 Apr. 2024.
Concannon, Kyle F., et al. “Outcomes among Homeless Patients with Non–Small-Cell Lung Cancer: A County Hospital Experience.” JCO Oncology Practice, vol. 16, no. 9, Sept. 2020, pp. e1004–e1014, https://doi.org/10.1200/jop.19.00694. Accessed 2 Mar. 2024.
Dembosky, April, et al. “When Homelessness and Mental Illness Overlap, Is Forced Treatment Compassionate?” NPR, 31 Mar. 2023, www.npr.org/sections/health-shots/2023/03/31/1164281917/when-homelessness-and-mental-illness-overlap-is-compulsory-treatment-compassiona. Accessed 24 Apr. 2024.
Elmore, Eric. “The Raw Society | There Is No They.” The Raw Society, therawsociety.org/there-is-no-they/. Accessed 24 Apr. 2024.
Eshtehardi, Sahar S., et al. “Sociodemographic Determinants of Nonadherence to Depression and Anxiety Medication among Individuals Experiencing Homelessness.” International Journal of Environmental Research and Public Health, vol. 18, no. 15, 28 July 2021, p. 7958, https://doi.org/10.3390/ijerph18157958. Accessed 24 Apr. 2024.
Farrell, Susan J., et al. “Examining Health Literacy Levels in Homeless Persons and Vulnerably Housed Persons with Mental Health Disorders.” Community Mental Health Journal, vol. 56, 19 Dec. 2019, https://doi.org/10.1007/s10597-019-00525-2.
Healthcare.gov. “See How Health Insurance Coverage Protects You.” HealthCare.gov, www.healthcare.gov/why-coverage-is-important/#:~:text=Health%20insurance%20protects%20you%20from. Accessed 2 Mar. 2024.
Hubler, Shawn. “Once a Sure Thing, Newsom’s Homelessness Measure Barely Passes.” The New York Times, 21 Mar. 2024, www.nytimes.com/2024/03/20/us/california-prop-1-homelessness.html. Accessed 24 Apr. 2024.
Hugtenburg, Jacqueline, et al. “Definitions, Variants, and Causes of Nonadherence with Medication: A Challenge for Tailored Interventions.” Patient Preference and Adherence, vol. 7, no. 7, July 2013, p. 675, www.ncbi.nlm.nih.gov/pmc/articles/PMC3711878/pdf/ppa-7-675.pdf, https://doi.org/10.2147/ppa.s29549. Accessed 2 Mar. 2024.
Jain, Sachin H. “Homelessness Is a Healthcare Issue. Why Don’t We Treat It as One?” Forbes, 17 Apr. 2021, www.forbes.com/sites/sachinjain/2021/04/17/homelessness-is-a-healthcare-issue-why-dont-we-treat-it-as-one/?sh=75a82eeb77e3. Accessed 2 Mar. 2024.
Jean, Melissa. A PublicAtion of the Hch CliniciAns’ Network Preventive Care for People Experiencing Homelessness Part I of II in a SerIeS on PreventIve Care. 2017.
Jones, Sue. “The Noncompliant vs the Non-Adherent Patient | the Cooperative of American Physicians.” Www.capphysicians.com, 11 May 2016, www.capphysicians.com/articles/noncompliant-vs-non-adherent-patient. Accessed 2 Mar. 2024.
Kahntroff, Jeffrey, and Rochelle Watson. “Refusal of Emergency Care and Patient Dumping.” AMA Journal of Ethics, vol. 11, no. 1, 1 Jan. 2009, pp. 49–53, journalofethics.ama-assn.org/article/refusal-emergency-care-and-patient-dumping/2009-01, https://doi.org/10.1001/virtualmentor.2009.11.1.hlaw1-0901. Accessed 24 Apr. 2024.
Kleinsinger, Fred. “Understanding Noncompliant Behavior: Definitions and Causes.” The Permanente Journal, vol. 7, no. 4, 2003, pp. 18–21, www.ncbi.nlm.nih.gov/pmc/articles/PMC5571787/. Accessed 24 Apr. 2024.
Lee, Alexandria. “Disparities in Health Care for the Homeless | Institute for Health Policy Leadership.” Ihpl.llu.edu, Loma Linda University Health, 22 Jan. 2021, ihpl.llu.edu/blog/disparities-health-care-homeless#:~:text=In%20addition%20to%20continuing%20to. Accessed 24 Apr. 2024.
Liu, Michael, and Stephen W. Hwang. “Health Care for Homeless People.” Nature Reviews Disease Primers, vol. 7, no. 1, 14 Jan. 2021, pp. 1–2, www.nature.com/articles/s41572-020-00241-2, https://doi.org/10.1038/s41572-020-00241-2. Accessed 2 Mar. 2024.
Mantel, Jessica. REFUSING to TREAT NONCOMPLIANT PATIENTS IS BAD MEDICINE. 1 Oct. 2017.
Molloy, Gerard J., et al. “Intentional and Unintentional Non-Adherence to Medications Following an Acute Coronary Syndrome: A Longitudinal Study.” Journal of Psychosomatic Research, vol. 76, no. 5, May 2014, pp. 430–432, https://doi.org/10.1016/j.jpsychores.2014.02.007.
National Alliance to End Homelessness. “Chronically Homeless.” National Alliance to End Homelessness, Dec. 2023, endhomelessness.org/homelessness-in-america/who-experiences-homelessness/chronically-homeless/#:~:text=Chronic%20homelessness%20is%20used%20to. Accessed 24 Apr. 2024.
---. “Demographic Data Project: Race.” National Alliance to End Homelessness, endhomelessness.org/demographic-data-project-race/#:~:text=Among%20the%20nation. Accessed 24 Apr. 2024.
Nineham, Laura. “Medical Ethics: Autonomy.” The Medic Portal, 2020, www.themedicportal.com/application-guide/medical-school-interview/medical-ethics/medical-ethics-autonomy/. Accessed 24 Apr. 2024.
Romaszko, Jerzy, et al. “Mortality among the Homeless: Causes and Meteorological Relationships.” PLOS ONE, vol. 12, no. 12, 21 Dec. 2017, p. e0189938, https://doi.org/10.1371/journal.pone.0189938. Accessed 2 Mar. 2024.
Saldua, Mark. “Addressing Social Determinants of Health among Individuals Experiencing Homelessness.” Substance Abuse and Mental Health Services Administration, 15 Nov. 2023, www.samhsa.gov/blog/addressing-social-determinants-health-among-individuals-experiencing-homelessness. Accessed 24 Apr. 2024.
Sleath, Betsy L., et al. “Literacy and Perceived Barriers to Medication Taking among Homeless Mothers and Their Children.” American Journal of Health-System Pharmacy, vol. 63, no. 4, 15 Feb. 2006, pp. 346–351, https://doi.org/10.2146/ajhp050070. Accessed 24 Apr. 2024.
The Medic Portal. “Medical Ethics: Beneficence.” The Medic Portal, 30 Nov. 2020, www.themedicportal.com/application-guide/medical-school-interview/medical-ethics/medical-ethics-beneficence/. Accessed 24 Apr. 2024.
Unni, Elizabeth J., et al. “Medication Non-Adherence in the Homeless Population in an Intermountain West City.” INNOVATIONS in Pharmacy, vol. 5, no. 2, 1 Jan. 2014, https://doi.org/10.24926/iip.v5i2.342. Accessed 2 Mar. 2024.
USA facts. “How Many Homeless People Are in the US? What Does the Data Miss?” USAFacts, 16 Mar. 2023, usafacts.org/articles/how-many-homeless-people-are-in-the-us-what-does-the-data-miss/. Accessed 2 Mar. 2024.
van Dulmen, Sandra, et al. “Patient Adherence to Medical Treatment: A Review of Reviews.” BMC Health Services Research, vol. 7, no. 1, 17 Apr. 2007, bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-7-55, https://doi.org/10.1186/1472-6963-7-55. Accessed 2 Mar. 2024.
Wise, Caitlin, and Kenneth Phillips. “Hearing the Silent Voices: Narratives of Health Care and Homelessness.” Issues in Mental Health Nursing, vol. 34, no. 5, 1 May 2013, pp. 359–367, eds.a.ebscohost.com/eds/detail/detail?vid=1&sid=6378a53b-801c-4573-924d-5ecefa88919b%40sessionmgr4008&bdata=JkF1dGhUeXBlPXNoaWImc2l0ZT1lZHMtbGl2ZQ%3d%3d#AN=23663023&db=mdc, https://doi.org/10.3109/01612840.2012.757402. Accessed 2 Mar. 2024.
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