Informed Consent with Homeless Patients

Abstract

Access to healthcare for homeless persons is a significant problem within the United States. However, as barriers are lessened through federally funded or philanthropic organizations, attention must be paid to ensuring quality healthcare. The homeless population has disproportionately high rates of substance abuse, mental health disorders, and traumatic brain injuries. This places these patients at greater risk for lacking capacity to consent. This study was designed to examine the informed consent practices of healthcare practitioners in the primary care setting of clinics having received the federal Healthcare for the Homeless grant. Due to the poor response rate, no data of statistical significance were obtained and the study was treated as a pilot study. Patient demographics closely mirrored national statistics of homelessness excepting ethnicity. Likewise, patients seen in these clinics experience high rates of substance abuse and mental health disease. Providers reported only low rates of traumatic brain injuries in their population, contrary to national statistics demonstrating high rates of this disorder. Despite the high prevalence of risk factors for incapacity to consent, providers rarely questioned their patients’ decisional capacity. Practices involving informed consent varied widely. Further studies need to be conducted to evaluate informed consent practices though it is apparent that studies of this nature may be impractical and unethical, if not impossible.