Description
You may also use these cases to write your three case analyses. However, not all of them have discussion questions to answer. Only choose cases with at least three discussion questions. 1
Case Study – Nursing Staff in Moral Distress When Patient Wishes Not Followed
Freda is a 32-year-old lady living in a long-term care facility who is chronically ill with multiple sclerosis. She voices desires to die peacefully and not to have a feeding tube placed. She is taken by her mother to a neurologist and when she returns, she has a feeding tube. Read this case to see how nursing staff responded. Questions
- What factors about Freda’s case led to moral distress on the part of the long-term care facility staff?
- Is their attack on the mother an appropriate response? Can it be justified?
- What explains the attending physician’s acquiescence to the existence of a feeding tube in his patient?
- What arguments can you provide the staff when they confront the physician?
- What should they do, if the physician remains unwilling to act on their concerns?
- Has the neurologist acted responsibly?
- What ethical principles, virtues, or consequences do you think play a role in the patient’s suffering, and the staff’s moral distress?
- What information do you have that would lead you to believe that the patient has decisional capacity?
- Do patients have the right to refuse artificial nutrition and hydration? How would you help Freda explain her wishes to her mother and aunt?
Case Study – Refusal to Eat in a Long Term Care Facility
John is a 92-year-old who was recently admitted to a long-term care facility after being discharged from the hospital after a stay for pneumonia. He is nonverbally refusing meals, and with no obvious family members to relay his wishes, staff are finding it hard to determine what the next step should be in his care .Questions:
- How can John’s capacity for decision making be determined? Must it be through the services of a professional?
- If John is judged to be decisionally capacitated and thus his hand gesture means he no longer wants to eat, discuss the following distinctions:
- between “suicide” and “letting nature take its course”
- between nourishment as ordinary or extraordinary means (Does the fact that John can no longer feed himself point to nourishment as ordinary or extraordinary?)
- between oral and non-oral communication (Are they equally valid?
Case Study – Rejecting Doctors Orders
Herman is a 55-year-old farmer with worsening, chronic back pain refuses surgery and states he will go to the local chiropractor, instead His doctor is faced with a dilemma. He does not feel he can contact the chiropractor, but feels that the manipulation could worsen Herman’s injury.)
- Questions to consider:1) When does persuasion become coercion?2) When does Dr. X’s prediction of nerve dam age resulting from chiropractic manipulation become scientific knowledge?3) How much information does Herman need to make his choice? Can information become excessive?4) Are facts (information) essential for Herman’s informed choice to visit the chiropractor? Discuss the role information serves in decision-making?5) Although Dr. Jones has an X-ray machine in his office, to Dr. X’s knowledge, he has never been certified in performing or interpreting CAT scans. Should Dr. X attempt to share this data with Dr. Jones?
