For lack of a better plan: a framework for ethical, legal, and clinical challenges in complex inpatient discharge planning.

This article proposes a new theoretical framework for analyzing complex inpatient hospital discharge dilemmas. Each component of the framework is defined, illustrated with a hypothetical case, and discussed from legal,ethical and practical problem solving viewpoints. Patients who lack reasonable and safe discharge plans invariably challenge existing interpretations of autonomy, capacity, and justice. Such cases often require legal advice and sometimes intervention from the judicial system when alternatives are exhausted. As an extension of previous work on discharge planning (Swidler et al., 2007), this work strives to provide medical professionals with an organized way of approaching inpatient discharge barriers and to encourage new ways of considering and designing healthcare policy both to reduce discharge delays and also better to serve patients.