Yours sincerely, doctor X. An ethical reflection on employing patient-directed discharge letters in hospital care

Abstract

Patient-directed discharge letters (PDL) are letters sent to patients after hospital care. They are adjusted to patient needs in terms of language use and letter content. Their use is increasingly recommended and used in hospital care. Empirical research indicates their potential for improving care, HCP-patient relationships, and patient self-management. Yet, the ethical dimension of using has not been explored before. This thesis explores whether it is morally justified to use PDL, and if so, under what conditions. It employs the Normative Empirical Reflective Equilibrium as a method for moral reasoning. In this model, morally relevant facts, moral intuitions, ethical principles and background theories relevant for the use of PDL are considered. The analysis highlighted that negligent employment of PDL can risk reinforcing epistemic injustices or increasing health disparities. To avoid this, the use of PDL is justified under certain conditions. Based on these conditions, this ethical reflection concludes with a practical recommendation for just employment of PDL in hospital care, and an example PDL that meets these conditions.