Reducing homelessness and improving health outcomes for this vulnerable population are pressing issues facing Toronto and require urgent action grounded in ethical principles of justice and utilitarianism. Recent local news articles highlight alarming cases where homeless individuals have been denied basic healthcare, leading to needless suffering or death, which starkly reveals the inequities around access to care. Analyzing these cases through ethical frameworks clarifies healthcare providers’ moral obligations and how nurses can advocate for change. Upholding ethics is imperative to reform unjust practices and fulfill our shared responsibility to care for community members.
An article from July 2022 covers the tragic story of a homeless man who passed away in a shelter after being turned away from two emergency rooms in Toronto while experiencing heart failure symptoms (McQuigge, 2022). The hospitals told him to return when his condition worsened, but he died hours after finally returning to the shelter. This case contradicts fundamental principles of justice and fairness.
The social justice theory focuses on reducing inequalities, protecting human rights, and ensuring the fair distribution of resources and treatment in society (Beauchamp & Childress, 2019). Healthcare is viewed as a basic right that should be accessible to all. When vulnerable groups like people without homes face systemic barriers to accessing services, it violates equitable treatment under social justice (Beauchamp & Childress, 2019). Turning away sick individuals seeking care at hospitals is unethical discrimination that can cost lives. Healthcare providers have to ensure fair access.
Utilitarianism is another relevant ethical framework, which holds that decisions should maximize benefits and minimize harm for the greatest number of people (Driver, 2009). Allowing homeless patients to suffer without treatment fails under this view, as it produces immense and unnecessary pain and detriment. Caring for patients, on the other hand, promotes well-being for both individuals and the broader community. Especially when patients are vulnerable, healthcare workers must provide compassionate care to align with utilitarian ethics.
These frameworks elucidate hospitals’ ethical obligations to serve all patients in need, regardless of social or economic status. As the news article emphasizes, “Hospitals are still denying treatment for the most vulnerable in our society and letting them die needless deaths” (McQuigge, 2022). This status quo violates principles of justice and utility and must be reformed.
Nurses are important in upholding ethics and promoting change within healthcare systems. As patient advocates, nurses can apply ethical theories to analyze unjust policies and develop solutions. For example, nurses can advocate for improved discharge planning to link homeless patients to community resources (Buetow & Adair, 2013). They can also provide education to reduce other providers’ stigmatization of homeless patients (Zrinyi & Balogh, 2004). On an individual level, nurses have an ethical responsibility to ensure all patients receive quality care, showing compassion rather than judgment. They can model person-centered care that treats people without housing with dignity.
Nurses across Toronto are already working to fulfill these roles. One local nurse interviewed emphasizes that “there is still issues around stigma and bias impacting healthcare for the homeless” and calls for “systemic change” (McQuigge, 2022). She highlights the need for policies requiring discharge plans for homeless patients to coordinate follow-up care (McQuigge, 2022). Implementing such plans aligns with social justice principles around equitable access. It also serves the utilitarian purpose of supporting this population’s health. Through such advocacy efforts, nurses uphold their professional duty to protect patients’ well-being.
Other Toronto programs also showcase nursing’s role in addressing healthcare inequities for people without homes. Inner City Health Associates operates mobile clinics that bring healthcare directly to shelters and drop-in centers (Inner et al., 2017). This improves access and reduces barriers to care. Nurses provide frontline services at these clinics, guided by a mission to serve vulnerable communities. They put ethical principles into practice through their work.
While laws prohibit discrimination in healthcare, the reality still falls short for homeless populations who face stigma and inadequate policies. Analyzing such injustice using ethical lenses highlights the need for reform. As nurses promote equity and help transform practices to serve all people with dignity, they actualize core values. Nurses uphold critical ethical obligations to people without homes through advocacy, education, policy improvements, and high-quality care for each patient.
The pandemic of homelessness and barriers to healthcare in Toronto require immediate and meaningful action guided by ethics. These values align with the nursing profession’s fundamental duties to promote justice and maximize well-being. Nurses can lead change and model what equitable, compassionate care looks like on a systemic and individual level. As local health inequities persist, drawing on frameworks of social justice and utilitarianism should motivate and direct nursing efforts to address determinants of health. Although affecting change is challenging, nurses must hold fast to their ethical convictions in caring for people without homes and fulfilling their role as patient advocates.
References
Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.
Buetow, S., & Adair, V. (2013). Reconciling the irreconcilable: Providing integrated primary healthcare to homeless people. Health and Social Care in the Community, 21(5), 492-500. https://doi.org/10.1111/hsc.12042
Driver, J. (2009). The history of utilitarianism. In E. N. Zalta (Ed.), The Stanford encyclopedia of philosophy. https://plato.stanford.edu/entries/utilitarianism-history/
Inner City Health Associates. (2017). Who we are. https://www.innercityhealth.ca/who-we-are/
McQuigge, M. (2022, July 15). Advocates renew calls for better healthcare for homeless after man who couldn’t access care dies in Toronto shelter. Toronto Star. https://www.thestar.com/news/canada/2022/07/15/advocates-renew-calls-for-better-healthcare-for-homeless-after-man-who-couldnt-access-care-dies-in-toronto-shelter.html
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