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Homeless, Ill, and Psychiatrically Complex: The Grueling Carousel of Cassandra Lee

Abstract: Ask any clinical ethics consultant, and they can tell you about their transformative cases. Some stick with us because all roads led nowhere. Cassandra Lee had a history of pulling out lines and tubes and a distaste of warming blankets. Her admission marked her thirtieth over the past year. Many of the challenges facing the hospi­tal caring for her were not unique: significant psychiatric issues, prolonged nonadherence to medical advice, and end-of-life decision-making combined to create an ethically dense and vexing situ­ation. Ms. Lee, like so many patients, was suffering because of system failures.

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