Discharge to Nowhere: Recent Policy Changes, Ethics, and Transitions of Care for the Undocumented and Uninsured

Abstract: This paper explores the ethical dilemmas inherent in discharging undocumented, uninsured patients, exacerbated by recent policy changes. Two compelling cases illustrate the challenges: a 60-year-old non-English speaking man with an acute stroke, abandoned and without resources; and a 39-year-old non-English speaking woman with a citizen child, visiting the US, suffering a seizure, without resources or family support. These cases highlight the precarious circumstances faced by this vulnerable population, particularly regarding treatment and post-discharge care. We will examine the impact of current immigration and healthcare policies on discharge planning, examining ethical implications of various policy approaches, including expanded access, restricted access, and alternative care models. By fostering dialogue on the vulnerabilities of this population, we aim to contribute to an ethically sound and effective approach to discharge planning for undocumented patients, with the goal of promoting equitable and humane healthcare.

Keywords: Undocumented immigrants, Discharge planning, Community resources