The Americans with Disabilities Act was pushed through Congress with far less attention from the media than has accompanied other major civil rights bills. This was part of a deliberate and unconventional strategy by disability rights lobbyists who believed that media portrayals of disability were so cliched that journalists would impede, not further, the public's understanding of disability rights issues. Despite the success of the strategy, there is a price to pay for having been a ‘stealth’ civil rights movement: Now that the law is in place, disabled people face a backlash from Americans who neither understand the ADA nor the need for civil rights protection for disabled people.

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The question of optimal disposition for children with complex medical and social circumstances has long challenged the well-intentioned clinician. The coronavirus disease 2019 pandemic created unique difficulties for patients, families, and health care providers, in addition to highlighting long-standing racial and socioeconomic inequities in health care. In pediatric hospitals, necessary public health measures such as visitor restrictions shifted many shared decision-making processes such as discharge planning from complicated to impossible. Here, we present the case of a medically complex adult (with a long-standing pediatric condition) whose surrogate decision-maker objected to discharge to a long-term care facility because of restrictions and risks associated with the coronavirus disease 2019 pandemic. We offer the commentary of experts in clinical ethics, intensive care, inpatient subacute care, and palliative care. Our discussion includes analysis of the ethical considerations involved in the case, concrete guidance on steps toward an ethically permissible discharge, and suggestions for how a health equity lens can improve communication and decision-making for families who are victims of systemic racism and economic discrimination.

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