Background Average life expectancy in the homeless population is 47, and rates of homelessness are increasing significantly. With a high disease burden, these patients may benefit from palliative input, but historically there have been barriers to effective care.
Methods From consequentialist, virtue, and care ethics perspectives, two questions are addressed. Firstly, whether a coercive approach can be justified in a population who are traditionally reluctant to seek medical help, but may benefit greatly from treatment. Secondly, whether existing palliative services are appropriate for this group, or if there is ethical justification for a bespoke service, separate from mainstream healthcare.
Results Homelessness can be shown to effect the ability to make informed choices. Although there is ethical precedent for paternalistic approaches to health in such cases, for this population cultural capital, and so informed decision making, can be improved. We should therefore aim to increase the agency of homeless people, rather than further diminishing their rights.
Homeless people are often reluctant to engage with health services, and the care they receive is sub optimal. We should therefore avoid over medicalising end of life for this population, and focus on community based measures of care, which may emphasize social and psychological support over medical treatments.
Conclusion The homeless have not seen many of the health benefits of improved public health and primary prevention measures, and as such their life expectancy has remained static while others has improved. We frequently talk about a biopsychosocial model to health, but the focus is primarily on a biological approach. In this population, the focus should be reversed, with an emphasis on maintaining important social relationships and the psychological burden of disease in their situation.
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