A family divided.docx
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A 45-year-old man suffered a stroke leaving him paralyzed on his right side and unable to safely swallow food. There is disagreement over his decision-making capacity. His family is divided over whether to place a feeding tube. An ethics consultation is requested to discuss the patient's wishes, quality of life, clinical considerations, and how best to communicate with the divided family.
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This document discusses communication strategies in palliative care, including dealing with ambivalence, resistance, and breaking bad news. It presents case studies and evaluates how motivational interviewing techniques can help address common challenges in palliative care consultations, such as discussing prognosis, treatment goals, and end-of-life decisions with patients who may have conflicting values or perceptions. While motivational interviewing is generally well-suited to palliative care discussions, not all its techniques directly apply, as palliative care aims to help patients make values-consistent choices rather than guide them to particular decisions. Ambivalence is common in palliative care, and communication is important for ethical practice.
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1) The document discusses the case of a 90-year-old female patient with dementia and other medical issues who is being cared for by her daughter and son who disagree on her treatment plan.
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DQ 1 Response 1 As health care is advancing, there have been man.docx
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As health care is advancing, there have been many essential right concerning patients. The process of dying is very complex and it consequences are complicated. If one dies, the individual will not come back again. Therefore, individual with living will may promote care providers’ guideline to their destiny. It will prevent any litigation that may affect the care provider and the organization. Healthcare industry has now got involved or it is now involving spiritual treatment. Spiritual health care may have close relationship with end of life. The essential aspect to spiritual health care may include emotions, feelings, and assumptions of an individual. Therefore, it is very important to guide such essential concerning patient desire to have evidence. Sometimes patient do not want their family members to witness such desire because of the emotional consequences. Every patient knows the kind of pain their feeling and if this individual desire to end this suffering, others may not understand. Hence parent and family of a patient should not interfere in such situation. I can imagine a patient with a serious accident and is subjected to life support machine based on the patient’s unresponsive reaction. This patient has gone through treatment day and night for more than years. Such situation worsens the patient pain and suffering but who else can feel what the patient is feeling? Parent should decide on what they would do to their child regardless. In my opinion, the child will depend on the parent to survive living healthy. It would be very painful if the parent income -wise is poor. Which will lead the child to go through painful life. Therefore, parent knows their situation at hand and they need to make their own decision regardless.
Reference
Balk, E. D: Closing the gaps on efforts to improve healthcare quality at the end-of-life.
Russell, D: Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life by the Committee on Approaching Death: Addressing Key End of Life Issues. Washington, DC: National Academies Press, 2014. 638 pages.
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In the mid 1970s, a nursing educator in Idaho had contact, through a student, with a female client who had chronic myelogenous leukemia. This form of leukemia can often be managed for years with little or no chemotherapy. The woman had done well for about twelve years and ascribed her good condition to health foods and a strict nutritional regime. However, her condition had turned worse several weeks before and her physician had advised her that she needed chemotherapy if she were to have any chance at survival. The physician had also advised her of the potential side effects of the therapy including hair loss, nausea, fever, and immune system suppression.
The woman consented to the therapy and signed the appropriate forms, but later, she began to have second thoughts. The nursing educator and student had given the patient one dose of the therapy when the woman began to cry and express her reservations about the therapy. She questioned the nurse about alternative treatments to the use of chemotherapy. The patient related that she had accepted the therapy because her son had advised her that this was the best treatment. She related that she had not asked about alternate forms of treatment as the physician had indicated that chemotherapy was the only treatment indicated. The nurse did not discuss the patient's concerns with the physician, and later that evening, she talked to the patient about alternate therapies. In the discussion, rather nontraditional and controversial therapies were covered including reflexology and the use of laetrile. During the talk, the nurse made it very clear that the treatments under discussion were not sanctioned by the medical community.
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1. What, if anything, did the nurse do wrong?
2. Had she moved beyond her scope of practice?
3. Could the nurse's conduct be justified under the patient advocate portion of her role?
4. If you were a member of the state board for nursing and had to decide the issue of unprofessional conduct and interference with the patient-physician relationship, would you sanction the nurse?
Support your responses with evidence and cite your sources.
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COURSE MATERIAL INFORMATION
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2) Patients see medication as important but prefer alternative treatments and want doctors to focus on long-term treatment rather than just prescribing medication.
3) Family members' concerns about medication side effects like addiction influence patients' views, though patients still see medication as essential with proper support from doctors.
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1. The patient, a 54-year-old with leukemia, requests hastened death from the medical staff during a home visit due to feeling a loss of control over his deteriorating condition and not knowing how much time remains.
2. The medical staff evaluates the patient's decision-making capacity and explores the root causes of his suffering while intensifying treatment of his symptoms.
3. The staff member responds empathetically to the patient's emotions but does not agree to assist with hastened death, instead searching for alternative options that respect both patient autonomy and professional integrity.
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1) The document discusses the case of a 90-year-old female patient with dementia and other medical issues who is being cared for by her daughter and son who disagree on her treatment plan.
2) The daughter wants "everything done" and favors tube feeding, while the son believes the mother would not want aggressive treatment and the daughter is applying her own religious views.
3) A bioethics consultation was called to help resolve the disagreement. They determined the patient's advance directive stated she would not want prolonged feeding if recovery was unlikely. They recommended the son's decisions align more with the patient's wishes.
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DQ 1 Response 1
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Reference
Balk, E. D: Closing the gaps on efforts to improve healthcare quality at the end-of-life.
Russell, D: Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life by the Committee on Approaching Death: Addressing Key End of Life Issues. Washington, DC: National Academies Press, 2014. 638 pages.
Response 2
Assess the ethical issues surrounding end-of-life decisions. How has the living will affected medical response and why is this important for guiding end-of-life decisions? Should families be able to impact how and if a person's living will is carried out? Should parents have the right to choose to end the life of their child if the child has Down Syndrome?
Living wills are very important. They are legal documents that lay out decisions that the patient has made for their health care in the event that they are unable to make decisions anymore. Decisions that are made could include if the patient wants to be resuscitated or kept on life support. Furthermore, a living will can have the patients in regards to pain management or organ donation. (Mayo Clinic Staff, 2017) This is way if the patient’s family or friends do not agree it goes back to the patient’s .
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This document discusses physician assisted death (PAD) and euthanasia. The purpose is to research whether legalizing end of life care would increase death rates. PAD is defined as a physician providing a lethal medication at a patient's request to end their suffering from a terminal illness. Euthanasia is when a physician directly administers the lethal drug. While the public finds euthanasia more acceptable, support decreases if PAD is referred to as suicide. Arguments against include concerns that requests stem from undiagnosed mental illness. Arguments for note Oregon's strict process, including multiple requests and evaluations, to ensure informed consent. It raises the question of whether the mentally ill should be eligible.
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This document summarizes key topics related to end-of-life decision making, including:
1) Ethically sound and legally mandated end-of-life decisions as well as the responsibilities of surrogate decision makers.
2) What constitutes futile care and how to deal with cultural and religious needs in end-of-life care.
3) The importance of documenting end-of-life decisions in the medical record and giving patients and surrogates sufficient information to make informed decisions.
For this assignment, consider the following case and then using th.docx
For this assignment, consider the following case and then using the internet, course materials, and the Library, compose reasoned responses to the questions that follow.
In the mid 1970s, a nursing educator in Idaho had contact, through a student, with a female client who had chronic myelogenous leukemia. This form of leukemia can often be managed for years with little or no chemotherapy. The woman had done well for about twelve years and ascribed her good condition to health foods and a strict nutritional regime. However, her condition had turned worse several weeks before and her physician had advised her that she needed chemotherapy if she were to have any chance at survival. The physician had also advised her of the potential side effects of the therapy including hair loss, nausea, fever, and immune system suppression.
The woman consented to the therapy and signed the appropriate forms, but later, she began to have second thoughts. The nursing educator and student had given the patient one dose of the therapy when the woman began to cry and express her reservations about the therapy. She questioned the nurse about alternative treatments to the use of chemotherapy. The patient related that she had accepted the therapy because her son had advised her that this was the best treatment. She related that she had not asked about alternate forms of treatment as the physician had indicated that chemotherapy was the only treatment indicated. The nurse did not discuss the patient's concerns with the physician, and later that evening, she talked to the patient about alternate therapies. In the discussion, rather nontraditional and controversial therapies were covered including reflexology and the use of laetrile. During the talk, the nurse made it very clear that the treatments under discussion were not sanctioned by the medical community.
The patient's feelings toward alternate therapies were strengthened by the evening's conversation; however, she continued with chemotherapy. The treatments, however, did not bring remission to her crisis and she died two weeks later. Upon hearing about the conversation between the off duty nurse educator and his patient, the physician brought charges against the nurse for unprofessional conduct and interfering with the patient-physician relationship. (In re Tuma, 1977).
1. What, if anything, did the nurse do wrong?
2. Had she moved beyond her scope of practice?
3. Could the nurse's conduct be justified under the patient advocate portion of her role?
4. If you were a member of the state board for nursing and had to decide the issue of unprofessional conduct and interference with the patient-physician relationship, would you sanction the nurse?
Support your responses with evidence and cite your sources.
Length 4 pages not counting the case. At least 4 references; scholarly sources
COURSE MATERIAL INFORMATION
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CHAPTER18End-of-Life Issues© sfam_photoShutterstockWhen
CHAPTER18
End-of-Life Issues
© sfam_photo/Shutterstock
When we finally know we are dying, and all other sentient beings are dying with us, we start to have a burning, almost heart breaking sense of the fragility and preciousness of each moment and each being, and from this can grow a deep, clear, limitless compassion for all beings.
—Sogyal Rinpoche
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The reader, upon completion of this chapter, will be able to:
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• Describe how patient autonomy has been impacted by case law and legislative enactments.
• Discuss the following concepts: preservation of life with limits, euthanasia, advance directives, futility of treatment, withholding and withdrawal of treatment, and do-not-resuscitate orders.
• Explain end-of-life issues as they relate to autopsy, organ donations, research, experimentation, and clinical trials.
• Describe how human genetics and stem cell research can have an impact on end-of-life issues.
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1. Leroy died suddenly, leaving behind him Margret, his wife, who was suffering from atherosclerosis (hardening of the arteries) of the brain, for whom he had cared devotedly because she was practically an invalid. In his will, he left his substantial estate to her, to go upon her death to his side of the family. He had actually earned all the money because Margret had never gone to work. Margret’s sister, Anne, and her husband Eric an attorney agreed to take care of her, putting her into a skilled nursing facility near their home for which all expenses were paid from Leroy’s estate. While she was still alive, they changed Margret’s will, splitting the estate 40/60 in favor of her side of the family. They had a doctor certify that she was mentally competent to make such a change, but Leroy’s family, who had visited her, noticed that she was capable of very little in the way of decision-making. As longtime friend of Anne and Eric, they had trusted them not to do anything improper. When they learned that Anne and Eric had changed Leroy’s will under what they felt to be very shady circumstances, they accused them of stealing.
Do you believe that what Anne and Eric did was theft? Why or why not? If they felt their side of family had been wronged, was there anything that Anne and Eric could have done differently to rectify the problem?
2. A psychologist wants to videotape some of his patients during their therapy sessions, partly as a study he is doing and partly as a teaching device for advanced psychology students. He feels that if the patients know they are being taped, they won’t act naturally, which will both taint his study and diminish the film’s value as a teaching device. For this reason, he feels that the patients should not know that they are being taped even though what they do or say on the tape may reveal certain aspects of their private feelings and lives.
What should the psychologist do? Should he tell the patients he is taping them, or should he just go ahead and tape without their permission, assuming that he is just going to use the tapes for his own research and as a teaching device? Are there any other alternatives you can think of for the psychologist to follow?
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Case#1
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Questions:
1. What is the diagnosis of this patient?
2. What is the age onset of this disorder?
3. What socioeconomic group suffers from this disorder?
4. What is the subtype of this disorder in this patient ?
5. List five positive and negative symptoms that we can find in schizophrenia disorder>
6. What is the treatment?
7. What are five characteristics associated with better prognosis?
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Qu.
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The document discusses several cases involving complex medical ethics issues:
1) The case of a man with Down syndrome whose health is declining. His parents disagree on whether to remove his feeding tube.
2) A family is divided on whether to place a feeding tube for their father who is minimally conscious with no chance of improvement.
3) The document provides advice for communicating with families in these difficult situations, considering the patient's values and preferences to make the most ethical decision. Outcomes for the patient's well-being and avoiding prolonged suffering are important factors discussed.
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Mental Health Newsletter 28 June 2013
Ian Brady's application to be transferred from Ashworth Hospital to prison was rejected after an 8-day hearing. The tribunal found that Brady continues to meet the criteria for detention under the Mental Health Act. Brady argued he has no detainable disorder and should be allowed to return to prison, where he has threatened to starve himself to death. Ashworth Hospital argued that Brady has both a personality disorder and a mental illness (schizophrenia), and that his care in the hospital effectively manages his condition. The tribunal did not provide detailed reasons for its decision but found that Brady should remain in the hospital rather than be transferred to prison.
Sudore ctac talk-6-24-13
The document discusses advance care planning (ACP) and problems with traditional approaches focusing on advance directives. It summarizes research showing many patients do not understand forms or hypothetical scenarios. Focus groups identified 5 themes to better prepare for medical decision-making: 1) Identify a surrogate, 2) Reflect on values and past experiences, 3) Discuss flexibility for surrogates, 4) Inform family/friends of decisions, and 5) Ask clinicians about treatment outcomes. The author developed an interactive website called PREPARE addressing these themes. A pilot study found it improved engagement in ACP behaviors among diverse older adults based on a new ACP survey measuring behavior change processes and actions.
So, you think i’m crazy
Dr. E faces an ethical dilemma of whether to grant Claire's request to view her medical records. Allowing her to view the records could hurt her feelings but honor her autonomy and rights, while denying her could increase her paranoia but protect Dr. E's privacy. Dr. E ultimately decides to allow Claire to view her records and discuss them with her to honor ethical principles of autonomy, beneficence, justice, accountability and veracity. This leads to Claire gaining greater control and involvement in her care, controlling her paranoia, and improving her relationship and treatment with Dr. E.
A case study on cirrhosis of liver
The document outlines the objectives and case study of cirrhosis of the liver. It provides background information on the patient, including their health history, family history, physical examination findings, and developmental tasks. The key objectives of the case study are to gain in-depth knowledge of cirrhosis, gain confidence in handling similar cases, and fulfill partial course objectives. Cirrhosis is selected as it is a common cause of liver disease in the region due to alcoholism.
Caring Conversations: Talking about goals of care with patients and families
The document discusses goals of care and advance directives, providing evidence-based guidance on discussing end-of-life wishes and preferences with patients. It outlines tools and resources for starting conversations about advance care planning, including living wills, durable powers of attorney, and forms tailored for pediatric patients. The presentation also addresses barriers to discussing code status and provides suggestions for conducting effective family meetings on goals of care.
CHAPTER18End-of-Life Issues© sfam_photoShutterstockWhen
CHAPTER18
End-of-Life Issues
© sfam_photo/Shutterstock
When we finally know we are dying, and all other sentient beings are dying with us, we start to have a burning, almost heart breaking sense of the fragility and preciousness of each moment and each being, and from this can grow a deep, clear, limitless compassion for all beings.
—Sogyal Rinpoche
Learning Objectives
The reader, upon completion of this chapter, will be able to:
• Discuss the human struggle to survive and the right to autonomous decision making.
• Describe how patient autonomy has been impacted by case law and legislative enactments.
• Discuss the following concepts: preservation of life with limits, euthanasia, advance directives, futility of treatment, withholding and withdrawal of treatment, and do-not-resuscitate orders.
• Explain end-of-life issues as they relate to autopsy, organ donations, research, experimentation, and clinical trials.
• Describe how human genetics and stem cell research can have an impact on end-of-life issues.
The human struggle to survive and dreams of immortality have long been instrumental in inspiring medicine to develop the means to prevent and cure illness. Advances in medical technology have resulted in the power to prolong a productive life, as well as to delay inevitable death. Those victims of long-term pain and suffering, as well as patients in vegetative states and irreversible comas, are the most directly affected. A longer survival involves considerable cost and can therefore be a substantial financial burden to the family and the government. Is it worth it? How do we make a judgment about quality of life? What is the financial value of another day, week, or year of life? Should we assume that younger years are better than older years? The following reality check provides some perspective as to how one might respond to the preceding questions.
End of Life or Beginning of Life?
My mother is 92 years old, and she is more active and is enjoying life more than when she was much younger. Her advanced age has actually proven to be something of an advantage, as it has given her the time and freedom to do some of the things she couldn’t do while she was raising a family. It has been a joy to me, as her son, and to the rest of the family to witness her joy and vigor. Even strangers have found her stamina to be an inspiration as to the value of the end years of life. Three years ago, however, it wasn’t so. Mother was critically ill, comatose on a respirator in an intensive care unit. Survival was not considered likely. I am embarrassed to say that I was making arrangements for a funeral. I am even more embarrassed because I am a physician and did not see how she could survive for long except as a vegetable. Then the unlikely occurred. She recovered! Her condition rapidly and surprisingly improved dramatically including both physical and mental status, and she promptly resumed a life even more active than before. It would have been a tra ...
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The document discusses the importance of taking a thorough sexual history from patients. It notes that sexual dysfunction is common, affecting around 30-40% of men and women, and can be an indicator of physical or mental health issues. However, many patients do not discuss sexual problems with their doctors due to embarrassment or other barriers. The document provides guidance on how to take a sensitive sexual history, including ensuring privacy, using patient-centered language, addressing potential biases, and exploring biological, psychological, and relationship factors. It emphasizes creating a comfortable, non-judgmental environment to discuss sexual health issues.
Diversity and Health Assessments.docx
This document discusses a health assessment of a 23-year-old Native American male who reports experiencing anxiety, smoking marijuana, and drinking alcohol. It notes his family history of diabetes, hypertension, and alcoholism. The document summarizes several research articles discussing health issues that disproportionately impact Native American communities, such as high rates of tobacco and alcohol use, heart disease, and diabetes. It also provides guidance on conducting a sensitive health assessment, including monitoring the patient's behavior, asking open-ended questions, and considering factors like age, eye contact, and use of an interpreter if needed.
Diversity and Health Assessments.docx
This document discusses a health assessment of a 23-year-old Native American male who reports experiencing anxiety, smoking marijuana, and drinking alcohol. It notes his family history of diabetes, hypertension, and alcoholism. The document summarizes several research articles discussing health issues that disproportionately impact Native American communities, such as high rates of tobacco and alcohol use, heart disease, and diabetes. It also provides guidance on conducting a sensitive health assessment, including monitoring the patient's behavior, asking open-ended questions, and considering factors like age, eye contact, and use of an interpreter if needed.
Promoting Person Centred Approaches Support Workers 2014
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Molst ppt for public
The document discusses end-of-life planning and provides information about living wills, medical power of attorney, and forms like MOLST. It notes that most people say they want to die at home but only 20% actually do. It emphasizes the importance of documenting one's end-of-life wishes and having conversations with loved ones to ensure one's autonomy and values are respected during the dying process.
ETHICS.ppt
This document discusses ethics and ethical principles in nursing. It begins by defining key concepts like morals, values, beliefs, ethics and ethical principles. It then outlines five learning objectives related to differentiating between these concepts, defining ethics, discussing ethical principles in clinical contexts, identifying nursing codes of ethics, and applying ethics concepts to clinical situations. The document proceeds to define values, beliefs, and how personal and professional values develop. It also outlines several professional nursing values and defines morals, ethics, and ethical principles like autonomy, nonmaleficence, beneficence, justice, fidelity, confidentiality, veracity and accountability. The document concludes by discussing ethical dilemmas, codes of nursing ethics, and approaches to resolving ethical issues
"As You Wish": Advance Care Planning
A slideshow that explains end of life decision making, including living wills, health care powers of attorney, and other helpful tools. Includes information on end of life laws in Delaware.
As You Wish: Advance Care Planning
Powerpoint slideshow explaining living wills, health care powers of attorney, and other end-of-life decision-making tools.
1. Leroy died suddenly, leaving behind him Margret, his wife, who .docx
1. Leroy died suddenly, leaving behind him Margret, his wife, who was suffering from atherosclerosis (hardening of the arteries) of the brain, for whom he had cared devotedly because she was practically an invalid. In his will, he left his substantial estate to her, to go upon her death to his side of the family. He had actually earned all the money because Margret had never gone to work. Margret’s sister, Anne, and her husband Eric an attorney agreed to take care of her, putting her into a skilled nursing facility near their home for which all expenses were paid from Leroy’s estate. While she was still alive, they changed Margret’s will, splitting the estate 40/60 in favor of her side of the family. They had a doctor certify that she was mentally competent to make such a change, but Leroy’s family, who had visited her, noticed that she was capable of very little in the way of decision-making. As longtime friend of Anne and Eric, they had trusted them not to do anything improper. When they learned that Anne and Eric had changed Leroy’s will under what they felt to be very shady circumstances, they accused them of stealing.
Do you believe that what Anne and Eric did was theft? Why or why not? If they felt their side of family had been wronged, was there anything that Anne and Eric could have done differently to rectify the problem?
2. A psychologist wants to videotape some of his patients during their therapy sessions, partly as a study he is doing and partly as a teaching device for advanced psychology students. He feels that if the patients know they are being taped, they won’t act naturally, which will both taint his study and diminish the film’s value as a teaching device. For this reason, he feels that the patients should not know that they are being taped even though what they do or say on the tape may reveal certain aspects of their private feelings and lives.
What should the psychologist do? Should he tell the patients he is taping them, or should he just go ahead and tape without their permission, assuming that he is just going to use the tapes for his own research and as a teaching device? Are there any other alternatives you can think of for the psychologist to follow?
3. Laura, a 19 years old woman, fell into a coma because of an overdose of drugs and alcohol. She was given emergency treatment at a hospital and was placed on a respirator, which stabilized her breathing. She remained in a deep coma, and when she was tested by neurologists; and neurosurgeons it was discovered that about 70 percent of her brain was irretrievably damaged. She was not brain dead, however: she reacted to pain, her eyes sometimes would open and her pupils contract, she would at times thrash about and her EEG showed some brain activity. She was in a PVS. Because she could not be pronounced dead in any medical or legal sense, the hospital and doctors refused to take her off the respirator or to stop any other treatments they were giving her. At one p ...
SelfConcept
The patient, a 70-80 year old female, underwent an abdominoperieal resection (APR) to treat rectal cancer. This resulted in a permanent colostomy bag. During the nursing shift, the patient's mood declined and she expressed a desire to die, feeling useless and like a burden. The nurse assessed the patient's self-concept, finding impacts to her physical, intellectual, and moral selves from the surgery and colostomy bag. The nurse aims to support the patient's self-esteem and expedite recovery through building trust and encouraging positivity.
Case#1A 24-year-old male graduate student without prior medical .docx
Case#1
A 24-year-old male graduate student without prior medical or psychiatric history is reported by his mother to have been very anxious over the past 6 months, with increasing concern that people are watching him. He now claims to “hearing voices,” telling him what must be done to “ fix the country.” Important workup ? thyroid-stimulating hormone TSH, rapid plasma reagain (RPR), and brain imaging.
Questions:
1. What is the diagnosis of this patient?
2. What is the age onset of this disorder?
3. What socioeconomic group suffers from this disorder?
4. What is the subtype of this disorder in this patient ?
5. List five positive and negative symptoms that we can find in schizophrenia disorder>
6. What is the treatment?
7. What are five characteristics associated with better prognosis?
Case#2
Ms. Torrez is a 17-year-old Caucasian woman without prior psychiatric history who is brought to the Emergency room by ambulance after her parents called 911 when they found her having a seizure in their living room. She was admitted to the medical intensive care units in status epilepticus and was quickly stabilized with intramuscular lorazepam and fosphenytoin loading. Her heigh is 5 feet 6 inches, she is of medium build, and her weight is 101 lbs. (BMI16.3kg/m2). She does not suffer any medical conditions, and this is her first seizure. Laboratory workup shows an electrolyte imbalance as the most likely cause of the seizures. Although initially reluctant, she admits to purging with the use of ipecac several times this week. She reports that although she normally restricts her daily caloric intake to 500 calories, she regularly induces vomiting if her weight is above 100 lbs. Her last menstrual cycle was 1 year ago. Psychiatric consultation is requested in order to confirm the diagnosis
The on-call psychiatry notes in Terry’s chart
Patient appears underweight and younger than her stated age. She is mild distress, has a nasogastric tube in place, and exhibits poor eye contact. She reports feeling “sad” and admitted to experiencing constant preoccupation about her physical appearance and says, “I am fat; I hate my body.” She also reports insomnia, low energy levels, and history of self-harm behavior by cutting her forearms. She reports that she is careful hiding her symptoms from her parents, whom she describes as strict disciplinarians. She also expresses concerns that she will disappoint them.
Ms. Torrez’ parents describe her as a perfectionist. They say that she is involve in multiple school activities, takes advanced placement classes, and has been recently concerned about being accepted at her college of choice. They report that she maintains a 4.0 grade point average in high school, and they are expecting her to become a lawyer. Her parents have noticed that she is underweight and rarely see her eat but attributed this to stress from her many academic pursuits. Ms. Torrez’ mom was diagnosed with obsessive-compulsive disorder.
Qu.
Pre natal diagnosis and abortion bioethics
The document discusses several cases involving complex medical ethics issues:
1) The case of a man with Down syndrome whose health is declining. His parents disagree on whether to remove his feeding tube.
2) A family is divided on whether to place a feeding tube for their father who is minimally conscious with no chance of improvement.
3) The document provides advice for communicating with families in these difficult situations, considering the patient's values and preferences to make the most ethical decision. Outcomes for the patient's well-being and avoiding prolonged suffering are important factors discussed.
Assessment Should We Withhold Life The Martinez Case.docx
Mr. Martinez was a 75-year-old man hospitalized for an upper respiratory infection. He and his wife had requested no CPR. However, his oxygen was increased, causing respiratory failure. The case examines the ethical issues around limiting life support for Mr. Martinez given his directives, quality of life, his family's preferences, and relevant moral principles.
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International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar KanvariaCommunity pharmacy- Social and preventive pharmacy UNIT 5
Covered community pharmacy topic of the subject Social and preventive pharmacy for Diploma and Bachelor of pharmacy
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A family divided.docx
- 1. A family divided Topic: A family dividedPlease read the case study below and answer the questions at the end in paragraph form. Feel free to use as many sources as needed.A Family DividedA Case Study by Robert L. Potter?Discussion Questions by Rosemary FlaniganA forty-five-year-old man with a three-year history of cardiovascular disease has entered the hospital with a stroke that has paralyzed his right side and caused him to aspirate food of any consistency. His mental status is clouded and there is disagreement as to whether or not he has decisional capacity. His language capacity is only “ yes” and “ no,” and his responses are inconsistent. The attending physician is convinced that the patient has lost decisional capacity while two family members are equally convinced that he has decisional capacity. The patient’ s wife and two other children are ambivalent about his competency to make decisions. The prognosis for recovery of safe swallowing and speech approaches zero because of the dense damage to the cerebral cortex visible on brain imaging. Two neurological consultants have verified that recovery is likely to be minimal and that permanent, severe disability will be the outcome.?The patient does not have an advance directive. The patient’ s wife says that they never did discuss his preferences about life- sustaining treatment. She is convinced that he would not want to live in this disabled condition, but is uncertain whether to request the placement of a feeding tube. Two of her four adult children are strongly opposed to the tube placement, while the other two insist that not to do so would be to “ kill our father.” The patient’ s wife is torn between these two positions, but finally requests that the tube be placed.?The attending physician and the rest of the treatment team are opposed to placing the feeding tube. Their argument is that the patient has “ minimal consciousness” and will not improve. They define this as a futile situation with no reasonable expectation of recovery. Furthermore, two nurses claim that during previous hospitalizations for episodes of cardiovascular events the patient told them that he would not want to be sustained by artificial means —not by ventilators, renal dialysis, or tube feeding. It is their position that the patient has expressed his preference to not be kept alive in a futile situation.?The family requests an ethics consultation.Questions for discussion1. The judgment of futility should be a conclusion of a communications process, not a beginning. How would you propose beginning the communication??• Who should be present??• What information should be shared??• What alternatives are on the table??• What is your goal in participating in the discussion??2. The family is divided over whether or not their husband/father should be placed on a feeding tube. Consider and discuss the following statements:?• The effectiveness of the feeding tube is a clinical
- 2. matter.• The benefits of the feeding tube for the patient depend on the patient’ s wishes and quality of life, which the patient or the patient’ s surrogate and family must determine.• The burdens the treatment (feeding tube) imposes are a consideration for both parties.?3. Role play the discussion. Express your assumptions and loyalties and listen attentively to the other speakers.?4. Evaluate the role playing experience. Did it affect your view of the case?If yes, how will you advise the family and the healthcare providers??If not, what is to be done now??5. How would this case have been different if the attending physician had been the one asking for a consultation?