Opinion | Ethics Consult: Allow Co-Ed Hospital Room? MD/JD Weighs In

Welcome to Ethics Consult — an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true, but anonymized, patient care case, and then we provide an expert’s commentary.

Last week, you voted on whether a hospital should allow a co-ed room.

Should Ms. Rached make an exception to the historic practice of the hospital and temporarily admit Jenny to a room with a male patient?

Yes: 90%

No: 10%

And now, bioethicist Jacob M. Appel, MD, JD, weighs in.

Single-gender hospital rooms have historically been the norm in the U.S. Exceptions include emergency rooms and intensive care units, which are well-trafficked and generally make no effort to segregate men and women. Such separation serves no medical purpose. In fact, when hospitals are crowded, it can delay admissions to the medical floors from the emergency room. However, single-gender hospital rooms comply with the customs of a large segment of society, and some people may be uncomfortable sharing a room with a patient of another sex. Parts of Canada, most notably Alberta, have permitted co-ed hospital rooms since 2005. Such a policy can operate in three distinct ways: (1) all patients can be compelled to accept the first room available, no matter what the gender of the other occupant; (2) patients can be assigned to gender-blind rooms unless they overtly object to sharing a room with a person of the opposite gender; or (3) patients can be asked their preferences on the matter without prompting, and only those who express their willingness will be assigned to gender-blind rooms.

Opponents of gender-blind rooms often resort to arguments based on tradition or what is known as “the wisdom of repugnance,” a term coined by Leon Kass to explain things that are considered to be morally wrong even if it is difficult to articulate why they are morally wrong. Sometimes this is referred to as the “yuck factor.” Similar arguments, often cloaked in religion, are used in some nations to keep women and men from sitting together at weddings or on buses. Other opponents of co-ed rooms express fears for the safety of female patients, including the prospect of sexual assault, although no such cases have been reported in facilities that have adopted this approach. (Similar objections are frequently raised by those who oppose allowing transgender individuals to use restrooms that match their gender identities.) No safety concerns are unlikely to apply in cases like Aunt Jenny’s, where the male patient is comatose.

In cases where both parties are willing, one is hard-pressed to advance a plausible argument against such arrangements. A more complex situation arises where one of the patients is willing but the other patient is not able to express a preference — such as in Ms. Rached’s dilemma. In short, she is asked to decide what the default option should be in the absence of either objection or consent from the patient.

One other factor should play into Ms. Rached’s thinking. She must decide to what degree to rely upon long-standing policies and when to carve out an exception based upon distinctive circumstances. Hard-and-fast rules may mete out injustices on occasion, but they ensure a uniform fairness in the application of controversial policies. Those who argue for such rigid standards value the rule of law and would want the hospital to change its policy rather than to permit Ms. Rached to single-handedly circumvent it. In contrast, allowing for discretion often achieves justice in the short run but may permit arbitrary decisions in other cases or may set troublesome precedents that lead to injustice in the future. In addition to deciding whether admitting Jenny to a male patient’s room is the right thing to do at the moment, Ms. Rached must decide whether doing so is worth the consequences of such a decision for other patients in the future.

Jacob M. Appel, MD, JD, is director of ethics education in psychiatry and a member of the institutional review board at the Icahn School of Medicine at Mount Sinai in New York City. He holds an MD from Columbia University, a JD from Harvard Law School, and a bioethics MA from Albany Medical College.

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