Homeless Seeking Healthcare; Are Our Communities Failing This Ethical Challenge?

homeless man at a clinic

The homeless in our society often suffer from a lack of healthcare services.  While it is true that many  homeless refuse medical care due to addictions, low cognitive function, mistrust of people of authority or intellectual disabilities there are still those that desire to seek care but cannot.  If a person were to view this problem with a cold cursory look they might conclude that "you can lead a horse to water but you can't make them drink".  While this may be a true statement it does not release a modern society from fulfilling its obligation to its citizens.  Would we consider allowing an elderly person with dementia knowingly walk into traffic?  Would we sit by and allow a sick child to forgo going to the doctor because they "don't like the taste of the medicine?"  Surely not!  Yet, we allow a homeless person caught up in addiction or low cognitive skills to deteriorate before our eyes while doing nothing?  Tragically, that is what many communities do.  It is at this crossroads that we find an ethical dilemma.  APA Ethical Standards would indicate our failure as a society to cause no harm, Principle A: Beneficence and Nonmaleficence. 

"Everybody avoids me!"

Of those homeless that eventually make their way into the lobby of a doctor’s office or Emergency Room they often perceive a sense of not being welcome.  People stop and stare.  People don't engage them in conversation like other patrons; People take a wide girth around them as though they have some terrible disease.  These unwelcome signs are generally not spoken words but by how people react.  Others change seats, stare, hold their noses or move their children away.    "They smell, they are scary, they might try to hurt me, I don't want them touching me" fellow patrons remark when asked.  In 2007 a study was done of homeless perceptions of being welcomed at health care facilities in Toronto, Canada.  Perceptions there should be even more diminished than in the U.S. since the entire issue of healthcare coverage would be void due to socialized medicine in Canada.  Yet, even in that setting the homeless people surveyed over 60% felt unwelcome and avoided (Wen, Hudak & Hwang, 2007).

 In many communities far more concern is placed on a stray dog dodging in and out of traffic than a homeless person slowing cars down as they attempt to push their grocery cart containing all they own across the street.   Principle B, Fidelity and Responsibility is also violated as we fail to be faithful to the most vulnerable.     Finally, I believe Principle E, Respect for People's Right's and Dignity is violated in this situation as well.   Our communities  have failed to treat the homeless with respect and recognizing their rights afforded them under the law and by most moral and ethical codes.

References

Shane, P. G. (1996). What about America's homeless children? Hide and seek. Thousand Oaks, CA, US: Sage Publications, Inc.

Wen, C.K., Hudak, P.L., Hwang, S.W. (2007). Journal of General Internal Medicine, July, 2007, Volume 22, Issue 7, pp. 1011-1017, 06 April 2007.