Key Arguments in Unilateral Termination from Addiction Programs: A Discourse on Ethical Issues, Clinical Reasoning, and Moral Judgments

The potential for administrative discharge or premature termination of a patient’s treatment by rank-and-file program staff in the field of behavioral health and human services delivery is a routine occurrence. According to the most recent data by the Substance Abuse and Mental Health Services Administration (2014a), over 126,000 clients or 7.3% of admissions were expelled from drug addiction treatment in the U.S. Despite these occurrences, written policies outlining checks and balances in the use of administrative discharge procedures to ensure a more objective and methodological approach are underresearched and written polices are a likely exception. However, despite the sizable impact of this phenomenon on staff and patients-often spurring contentious debate in clinical staff meetings-an anemic body of literature exists in this important area of mental health ethics. This article examines key issues in the debate for and against discharge, and concludes with discussion oriented around empirical ethics as a course of action to further constructive dialogue and administrative discharge protocols to this controversial and highly polarized decision making process with moral, ethical, and clinical dilemmas underpinning administrative discharge.