You ask Dora about her wishes regarding being treated in the hospital versus being discharged and attending appointments for her antibiotic treatment in a community health clinic near her house. She makes it clear that she would like to continue being treated in the hospital. The hospital is a safe environment and her needs are being attended to. Her caregivers are alarmed by the risks that she poses to them, but Dora is fairly happy in the hospital.
Respecting her autonomous wishes would mean keeping Dora in the hospital. However, there is still the option of discharging her nonetheless since she is not fully adherent to treatment, and treating her is multiply risky (Hepatitis C positive; exposure to hidden needles; possible fentanyl exposure). Considering this option, her caregivers point out two things. First they point out that discharge contrary to Dora’s autonomous wishes would be bad for her. She would be unlikely to continue with her treatment. Second, they point out that Dora would be likely to show up at the hospital again just as ill, or worse than before, and she would again be admitted to the hospital. Even though Dora might not show up on their unit again, other care providers in the hospital would have to deal with the risks and issues she presents. So the ethical problems resulting from caring for Dora would merely be shuffled somewhere else in the hospital.
Moreover, it would unethical to discharge Dora contrary to her autonomous wishes. Discharge would likely do her harm, and this would not be justified by respecting her autonomy. However, if she wanted to be discharged home with a care plan in the community, this would be an ethical option. But her wish is to stay in the hospital; thus, it would be unethical to discharge her at this point in her care.