Band-Aids and Bridges: Ethics, Risk, and Serving our Most Vulnerable

Abstract: Physicians are expected to place patient interests above their own and accept some risk in providing health care. However, this does not mean physicians must accept unfettered risk in the provision of healthcare. We are left, then, with an open question about what degree of risk is ethically and morally acceptable in the care of patients? In this presentation, this question will be addressed specifically within the realm of care toward some of society’s most vulnerable persons, namely those who are housing insecure and without basic access to healthcare.

A way to provide care to our vulnerable populations is “street medicine,” where a small group of trained physicians go into the area of unhoused persons to provide preventive treatment at no cost to them. “Street medicine” provides care to those whose alternative is not being treated at all. However, the ethical literature of providing preventative “street medicine” is uncommon.

We begin by first contextualizing what we mean by “risk” in the provision of health care. Next, we discuss the concept of risk in the provision of care via “street medicine.” Here, we describe how and why current patient-care standards do not adequately apply toward addressing the unique risks we identify in the care of those who are housing insecure. We conclude with a discussion of what degree of risk should be acceptable when providing street medicine and ideas for modifying the delivery of care to maximize care of the unhoused while minimizing the risks involved with “street medicine.”

Thomas Harter, PhD – Director, Bioethics and Humanities, Gundersen Health System