Mrs. R. is an 87-year-old patient with advanced Alzheimer's disease who has been on a ventilator for 10 days due to pneumonia. Her family does not want continued aggressive treatment and feels she would not have wanted it. However, her doctor wants to transfer her to another facility for more treatment including rehabilitation in hopes she could eventually return to long-term care. The nurses are concerned about this scenario and how to respond to prevent moral distress given the family's wishes and Mrs. R.'s condition.

1. Ethical and Moral in policy DQ
Ethical and Moral in policy DQEthical and Moral in policy DQMrs. R., an 87- year- old
patient, has a past history that includes coronary artery disease, a previous stroke, and
advanced Alzheimer’s disease. Ten days ago, Mrs. R. was hospitalized for aspiration
pneumonia and has been ventilator dependent since being admitted to the intensive care
unit in a small rural hospital. Family members visit daily and have repeatedly voiced their
concern to the nursing staff about the continued ventilator that Mrs. R. is receiving, most
notably the fact that Mrs. R. would never have wanted such care. They also note that Mrs. R.
has not recognized them in past months and that they plan to visit less in future days, but
can be contacted should any change in Mrs. R.’ s condition occur. Her primary physician has
practiced in this community for multiple years; he is well known for his reluctance to
discontinue any type of life for any patient. When questioned, Dr. G.’ s consistent response
is, if this were his frail 92- year- old mother, he would prescribe the very same treatment for
her. Dr. G. has now requested that the nurses talk to the family about moving Mrs. R. to a
major medical center, where she can receive more advanced care, including vigorous
rehabilitation and physical therapy, so that she may eventually return to a long-
term nursing care facility. How might the nurses in this scenario respond to the physician’s
request? How would this scenario begin to cause moral distress among the nursing staff,
and what are the positive actions that the nurses might begin to take to prevent moral
distress?Read Exercise 4.1 (Guido, p. 44) and apply the MORAL model to resolve the
dilemma.Ethical and Moral in policy DQORDER NOW FOR CUSTOMIZED, PLAGIARISM-FREE
PAPERSRead the case study presented at the end of Chapter 3. Examine the above scenario
from the perspective of health care policy. How would you begin to evaluate the need for
the policy and the possible or lack of for the policy from your peers, nursing
management, and others who might be affected by the policy? Do the 10 questions outlined
by Malone (as listed in Guido, p. 50) assist in this process? Draft a proposed policy to
address the issue you have identified.What compelling right does this case address?Whose
rights should take precedence?Does a child (here, a competent 14-year old) have the right
to determine what will happen to him? Should he ethically have this right?How would you
have decided the outcome if his disease state had not intervened? Required
Textbook:Guido, G. W. (2014). Legal and ethical issues in nursing (6th ed.). Upper Saddle
River, NJ: Prentice Hall. ISBN: 978-0-1333-5587-1Pozgar, G. D. (2013). Legal and ethical
issues for health professionals (3rd ed.). Boston: Jones and Bartlett. ISBN: 978-1-4496-
7211-9Recommended Textbooks:Smith, M. H. (2012). The legal, professional, and ethical

2. dimensions of higher education (2nd ed.). Philadelphia: Lippincott. ISBN: 978-
0826199539Grace, P. (2013). Nursing ethics and professional responsibility in advanced
practice (2nd ed.). Boston: Jones and Bartlett. ISBN: 978-1449667429