Janice Keller, a 62-year-old woman, was diagnosed with Non-Hodgkin's Lymphoma in 2011. Over four years, her cancer progressed and her health declined despite treatments. In her final year, Janice expressed a desire to stop treatment and focus on quality of life. Her husband, as her medical power of attorney, wanted her to continue treatment. The medical team recognized the discrepancy between Janice's wishes and her husband's decisions. They conducted family meetings to ensure her husband made choices in Janice's best interest, but an ethical dilemma emerged if he could not. Current research finds end-of-life decision making to be a common oncology ethical issue.
Beneficence and non-maleficence are two important principles of bioethics. Beneficence refers to actions that are intended to benefit others, including preventing and removing harm. It can be seen through kindness, charity, and love. Beneficence includes benevolence and provenance. Non-maleficence means not inflicting harm. It focuses on not killing, causing pain, offense, or incapacitating others. These principles guide ethical decisions around treatment, such as withholding or withdrawing care when it will not benefit patients. They also distinguish between killing and letting die, where letting die may be acceptable if treatment is futile or refused but killing generally is not. Both principles aim to do
This document provides an introduction to medical ethics, including:
1) Defining medical ethics and its scope in medical practice.
2) Outlining various theories and principles of medical ethics such as beneficence, non-maleficence, autonomy, and justice.
3) Discussing the duties of doctors to uphold good standards of practice and care for patients.
End of life decision making and approaches to issues of futility power point Bernard Freedman
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.
The document discusses key principles of medical ethics:
- Autonomy, beneficence, nonmaleficence, and justice are the core ethical principles of medicine.
- When a patient lacks decision-making capacity, physicians must identify an appropriate surrogate and assist them in making decisions using substituted or best interest standards.
- Several case scenarios are presented to illustrate how these principles apply in situations involving consent, surrogate decision-making, and end-of-life care decisions.
A 20-year-old pregnant Hispanic woman was in a car accident and suffered internal bleeding. She refused a blood transfusion and emergency surgery due to her beliefs as a Jehovah's Witness. This presented an ethical dilemma for healthcare providers between respecting her autonomy or overriding her refusal to try to save her life. She delivered a stillborn baby and later died from her injuries despite attempts to stabilize her. Virtue ethics focuses on the patient's viewpoint and autonomy within the context of the situation. The ethical principles of respecting the patient's wishes and providing medical care were in conflict in this case.
The dilemma to use drugs for treatment as the standard for care creates problems for drug side effects that cause harm and death of patients.
The problem of the drug side effects and prescription errors kill more patients, according to Lazarus et al (1998), an "estimated of 106,000 deaths occur annually due to adverse drug side effects" for standard of care for "practicing medicine".
In the case of prescription drug, the ethical issue is standard of care for treatment, and is complicated because of adverse drug effect.
The dilemma for standard of care by drugs is the problem for unexpected adverse reaction to drug that harms patients for medical law, ethics, and bioethics.
The standard of care for practicing medicine is a drug for a treatment can never be about ethics between a doctor and a patient.
To think health care coverage for vaccination and immunization is standard of care for introducing virus, bacteria and toxin cause sickness for practicing medicine (use of drugs) for treatment.
There are no medical ethics that said 'to treat patients right by giving advice' instead, the standard of care is prescribing drugs with side effect is practicing medicine "drug" for compliance with treatment that cannot apply to the doctrine "to do no harm".
According "to the ethical guidance in the Era of managed Care" by Higgins & Hackett (2000), an analysis of the American College of Healthcare Executives' (ACHE) Code of ethics suggests, "the managed care revolution undermining the medical ethics and that it does not adequately address several ethical concerns." Bioethics is the study of life, moral and ethical issues for debate as it relates to medical policy and practice that were appropriate for legal standard and standard of care, which can arise from the relationship between biology, technology, medicine, politics, law and philosophy, especially in the application for life and reproduction such as the recent event about plan parenthood.
Without a change to the current system for standard of care of practicing medicine by diagnose diseases to prescribe drugs for treatment for health care coverage, the answer is no.
Presented at Kansas City University of Osteopathic Medicine 10/27/15 in Lecture Series in Bioethics. See live presentation here: https://www.youtube.com/watch?v=Dr3g3PeVKeo
Beneficence and non-maleficence are two important principles of bioethics. Beneficence refers to actions that are intended to benefit others, including preventing and removing harm. It can be seen through kindness, charity, and love. Beneficence includes benevolence and provenance. Non-maleficence means not inflicting harm. It focuses on not killing, causing pain, offense, or incapacitating others. These principles guide ethical decisions around treatment, such as withholding or withdrawing care when it will not benefit patients. They also distinguish between killing and letting die, where letting die may be acceptable if treatment is futile or refused but killing generally is not. Both principles aim to do
This document provides an introduction to medical ethics, including:
1) Defining medical ethics and its scope in medical practice.
2) Outlining various theories and principles of medical ethics such as beneficence, non-maleficence, autonomy, and justice.
3) Discussing the duties of doctors to uphold good standards of practice and care for patients.
End of life decision making and approaches to issues of futility power point Bernard Freedman
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.
The document discusses key principles of medical ethics:
- Autonomy, beneficence, nonmaleficence, and justice are the core ethical principles of medicine.
- When a patient lacks decision-making capacity, physicians must identify an appropriate surrogate and assist them in making decisions using substituted or best interest standards.
- Several case scenarios are presented to illustrate how these principles apply in situations involving consent, surrogate decision-making, and end-of-life care decisions.
A 20-year-old pregnant Hispanic woman was in a car accident and suffered internal bleeding. She refused a blood transfusion and emergency surgery due to her beliefs as a Jehovah's Witness. This presented an ethical dilemma for healthcare providers between respecting her autonomy or overriding her refusal to try to save her life. She delivered a stillborn baby and later died from her injuries despite attempts to stabilize her. Virtue ethics focuses on the patient's viewpoint and autonomy within the context of the situation. The ethical principles of respecting the patient's wishes and providing medical care were in conflict in this case.
The dilemma to use drugs for treatment as the standard for care creates problems for drug side effects that cause harm and death of patients.
The problem of the drug side effects and prescription errors kill more patients, according to Lazarus et al (1998), an "estimated of 106,000 deaths occur annually due to adverse drug side effects" for standard of care for "practicing medicine".
In the case of prescription drug, the ethical issue is standard of care for treatment, and is complicated because of adverse drug effect.
The dilemma for standard of care by drugs is the problem for unexpected adverse reaction to drug that harms patients for medical law, ethics, and bioethics.
The standard of care for practicing medicine is a drug for a treatment can never be about ethics between a doctor and a patient.
To think health care coverage for vaccination and immunization is standard of care for introducing virus, bacteria and toxin cause sickness for practicing medicine (use of drugs) for treatment.
There are no medical ethics that said 'to treat patients right by giving advice' instead, the standard of care is prescribing drugs with side effect is practicing medicine "drug" for compliance with treatment that cannot apply to the doctrine "to do no harm".
According "to the ethical guidance in the Era of managed Care" by Higgins & Hackett (2000), an analysis of the American College of Healthcare Executives' (ACHE) Code of ethics suggests, "the managed care revolution undermining the medical ethics and that it does not adequately address several ethical concerns." Bioethics is the study of life, moral and ethical issues for debate as it relates to medical policy and practice that were appropriate for legal standard and standard of care, which can arise from the relationship between biology, technology, medicine, politics, law and philosophy, especially in the application for life and reproduction such as the recent event about plan parenthood.
Without a change to the current system for standard of care of practicing medicine by diagnose diseases to prescribe drugs for treatment for health care coverage, the answer is no.
Presented at Kansas City University of Osteopathic Medicine 10/27/15 in Lecture Series in Bioethics. See live presentation here: https://www.youtube.com/watch?v=Dr3g3PeVKeo
M. Pharm: Research Methodology and biostatics SONALI PAWAR
This document outlines the contents of a lecture on research methodology and biostatistics delivered by Prof. Sonali R. Pawar. It covers various topics in medical ethics including: the history of medical ethics traced back to guidelines like the Hippocratic Oath; core values like autonomy, beneficence, non-maleficence; concepts like informed consent and confidentiality; criticisms of orthodox medical ethics; the importance of communication and guidelines/ethics committees; cultural concerns and conflicts of interest. It also discusses principles like double effect and end of life issues like futility.
Dr. Y misdiagnosed and overprescribed medication to patient X, which led to their death from a heart attack. This was a case of medical malpractice and unintentional tort. As a healthcare ethics consultant, I would provide training to Dr. Y on the four principles of healthcare ethics: autonomy, beneficence, non-maleficence, and justice. Training should cover informed consent, doing what is best for the patient, avoiding harm, and fairness. The goal is to prevent future ethical violations and protect patient safety.
Dr. Y misdiagnosed and overprescribed medication to Patient X, which led to their death from a heart attack. This was a case of medical malpractice and unintentional tort. Patient X's family could sue Dr. Y for negligence, having to prove that Dr. Y deviated from the standard of care by misreading the medication instructions and that this caused Patient X's death. Healthcare ethics principles of autonomy, beneficence and non-maleficence were violated. Providers must respect patient autonomy, act in their best interest, and do no harm. Ongoing training in healthcare ethics is important to avoid such violations and ensure principles of justice, respect and fairness are followed.
Dr. Pooja Pandey discusses medical ethics in a document containing several sections. She begins with introductions to medical ethics and bioethics, then discusses the evolution of ethics including landmark documents like the Hippocratic Oath and Nuremberg Code. She explains why ethics has become increasingly important and outlines principles of medical ethics including autonomy, beneficence, confidentiality, non-maleficence, and justice. She also discusses concepts like informed consent, veracity, fidelity, and ethical dilemmas. The document provides an overview of key topics in medical ethics.
This document discusses several principles of medical ethics: respect for autonomy, beneficence, non-maleficence, and justice. It examines ethical issues around end-of-life care for a premature baby, disclosure of genetic risk information to a family member, and allocation of limited health resources. Key considerations in each case involve balancing duties to the patient with duties to others and societal principles of fairness.
This document discusses several key issues in medical ethics including conflicts that can arise between patient/family values and treatment guidelines, the complex nature of healthcare ethics, and important principles like autonomy, beneficence, non-maleficence, justice, dignity, and truthfulness. It also summarizes two cases involving pharmaceutical companies illegally promoting drugs and a kidney transplant racket in India. Finally, it discusses the importance of patient safety, avoiding medical errors, and the ethical duty of physicians to disclose errors to protect patients.
This document discusses several ethical dilemmas that can arise at the end of life. It describes situations involving conflicts between clinicians and families over appropriate care, as well as conflicts within clinical teams. It also addresses issues around withdrawing or withholding treatment, physician assisted suicide, palliative sedation, and ensuring comfort at end of life. The document emphasizes the importance of open communication, establishing goals of care based on patient values and preferences, and providing care aimed at both cure and comfort.
The document discusses medical etiquette and confidentiality for caregivers. It covers proper etiquette for visiting patients, appearance, mannerisms, emotional involvement and medical procedures. It also discusses dealing with families, obtaining informed consent, and maintaining patient confidentiality. Caregivers are expected to treat patients with respect, empathy and discretion while obtaining consent and keeping medical information private.
This powerpoint covers the topics that pertain to the ethics of the medical fields and how they are used. We have provided articles, videos, and pictures for better understanding.
Medical ethics analyzes the practice of clinical medicine based on core values like autonomy, beneficence, non-maleficence, and justice. These values guide treatment plans and decisions, though sometimes conflicts arise that require balancing priorities. The field has a long history dating back to documents like the Hippocratic Oath and continues to evolve with new issues in medicine and treatments. It encompasses both practical application and scholarly work to ensure fair, balanced decisions across cultures.
1) Beneficence imposes a duty on doctors to always act for the good of their patients.
2) Determining the "good" of patients can be complicated due to conflicts between health interests and other interests like employment or religion.
3) Doctors must balance beneficence with avoiding paternalism, appreciate all interests, and negotiate to make health interests a priority while involving patients in decisions.
EUTHANASIA AND SUICIDE DYSTHANASIA ORTHOTHANASIA
ADMINISTRATION OF DRUGS TO THE DYING
ADVANCE DIRECTIVES END OF LIFE CARE PLAN OR DNR
NURSING ROLES AND RESPONSIBILTIES
ETHICAL DECISION MAKING PROCESS
The principles of doing “good” and not doing “harm” are the essence of every code of medical ethics. It is the duty of all medical professionals to their patients to exercise their professional skills in an ethical manner and to observe the laws of the community. The essential purpose is to ensure that the patients’ trust in the medical profession is deserved. This is achieved by protecting the patients and ensuring that they are able to obtain the maximum benefits available from the medicine. At the same time, the medical ethics aim to protect patients from the abuse that can occur when one person is in the position of power via-a-vis another
1. Cancer and its treatments can impact patient sexuality through biological, physical, and psychosocial factors like changes to the body, fertility issues, and emotional distress.
2. Nurses should conduct comprehensive assessments of patient sexuality through open communication, addressing cultural and personal factors, and utilizing models like PLISSIT.
3. Nurses can manage side effects on sexuality through treating symptoms, educating on intimacy options, and referring patients to supportive resources for physical and emotional wellbeing.
4. Nurses must overcome barriers like embarrassment through active listening, normalizing issues as treatable side effects, and focusing on holistic care of the patient's wellness.
The document discusses several ethical principles in healthcare including autonomy, beneficence, non-maleficence, and justice. It also reviews issues around patient competence, capacity, consent and best interests. Guidelines are provided around withdrawing treatment, Do Not Attempt Resuscitation orders, and considering a patient's wishes based on advance directives or views of family members when a patient lacks capacity.
Medical ethics is the discipline that deals with what we believe to be good or bad, right or wrong about the ends of Medicine and the means used to achieve those ends.
It is not about what we can do in a given set of circumstances. It is about what we should do in those circumstances.
Learning Objectives of this Presentation:
1. Appreciate the ethos of contemporary clinical ethics
2. Understand the function and responsibilities of ethics committees
3. Appreciate the clinical context of the core principles of medical ethics
4. Understand the relationship of ethics, science, law, politics, and professionalism
5. Examine different theories of ethics
Presentation by: Richard L. Wasserman, M.D., Ph.D.
Clinical Professor of Pediatrics
University of Texas Southwestern Medical School
2009
Do Not Resuscitate Orders : What They Mean ?SMSRAZA
Most doctors working in Acute areas know when and how to do CPR. However, most get stuck when it comes to ' When not to do CPR' due to cultural, social, ethical and legal issues attached.
Edição 166 do Diz Jornal, um jornal plural que aborda os mais variados temas desde internet, política, videogames até saúde e direitos do consumidor.
Acesse nosso site: http://dizjornal.com/
M. Pharm: Research Methodology and biostatics SONALI PAWAR
This document outlines the contents of a lecture on research methodology and biostatistics delivered by Prof. Sonali R. Pawar. It covers various topics in medical ethics including: the history of medical ethics traced back to guidelines like the Hippocratic Oath; core values like autonomy, beneficence, non-maleficence; concepts like informed consent and confidentiality; criticisms of orthodox medical ethics; the importance of communication and guidelines/ethics committees; cultural concerns and conflicts of interest. It also discusses principles like double effect and end of life issues like futility.
Dr. Y misdiagnosed and overprescribed medication to patient X, which led to their death from a heart attack. This was a case of medical malpractice and unintentional tort. As a healthcare ethics consultant, I would provide training to Dr. Y on the four principles of healthcare ethics: autonomy, beneficence, non-maleficence, and justice. Training should cover informed consent, doing what is best for the patient, avoiding harm, and fairness. The goal is to prevent future ethical violations and protect patient safety.
Dr. Y misdiagnosed and overprescribed medication to Patient X, which led to their death from a heart attack. This was a case of medical malpractice and unintentional tort. Patient X's family could sue Dr. Y for negligence, having to prove that Dr. Y deviated from the standard of care by misreading the medication instructions and that this caused Patient X's death. Healthcare ethics principles of autonomy, beneficence and non-maleficence were violated. Providers must respect patient autonomy, act in their best interest, and do no harm. Ongoing training in healthcare ethics is important to avoid such violations and ensure principles of justice, respect and fairness are followed.
Dr. Pooja Pandey discusses medical ethics in a document containing several sections. She begins with introductions to medical ethics and bioethics, then discusses the evolution of ethics including landmark documents like the Hippocratic Oath and Nuremberg Code. She explains why ethics has become increasingly important and outlines principles of medical ethics including autonomy, beneficence, confidentiality, non-maleficence, and justice. She also discusses concepts like informed consent, veracity, fidelity, and ethical dilemmas. The document provides an overview of key topics in medical ethics.
This document discusses several principles of medical ethics: respect for autonomy, beneficence, non-maleficence, and justice. It examines ethical issues around end-of-life care for a premature baby, disclosure of genetic risk information to a family member, and allocation of limited health resources. Key considerations in each case involve balancing duties to the patient with duties to others and societal principles of fairness.
This document discusses several key issues in medical ethics including conflicts that can arise between patient/family values and treatment guidelines, the complex nature of healthcare ethics, and important principles like autonomy, beneficence, non-maleficence, justice, dignity, and truthfulness. It also summarizes two cases involving pharmaceutical companies illegally promoting drugs and a kidney transplant racket in India. Finally, it discusses the importance of patient safety, avoiding medical errors, and the ethical duty of physicians to disclose errors to protect patients.
This document discusses several ethical dilemmas that can arise at the end of life. It describes situations involving conflicts between clinicians and families over appropriate care, as well as conflicts within clinical teams. It also addresses issues around withdrawing or withholding treatment, physician assisted suicide, palliative sedation, and ensuring comfort at end of life. The document emphasizes the importance of open communication, establishing goals of care based on patient values and preferences, and providing care aimed at both cure and comfort.
The document discusses medical etiquette and confidentiality for caregivers. It covers proper etiquette for visiting patients, appearance, mannerisms, emotional involvement and medical procedures. It also discusses dealing with families, obtaining informed consent, and maintaining patient confidentiality. Caregivers are expected to treat patients with respect, empathy and discretion while obtaining consent and keeping medical information private.
This powerpoint covers the topics that pertain to the ethics of the medical fields and how they are used. We have provided articles, videos, and pictures for better understanding.
Medical ethics analyzes the practice of clinical medicine based on core values like autonomy, beneficence, non-maleficence, and justice. These values guide treatment plans and decisions, though sometimes conflicts arise that require balancing priorities. The field has a long history dating back to documents like the Hippocratic Oath and continues to evolve with new issues in medicine and treatments. It encompasses both practical application and scholarly work to ensure fair, balanced decisions across cultures.
1) Beneficence imposes a duty on doctors to always act for the good of their patients.
2) Determining the "good" of patients can be complicated due to conflicts between health interests and other interests like employment or religion.
3) Doctors must balance beneficence with avoiding paternalism, appreciate all interests, and negotiate to make health interests a priority while involving patients in decisions.
EUTHANASIA AND SUICIDE DYSTHANASIA ORTHOTHANASIA
ADMINISTRATION OF DRUGS TO THE DYING
ADVANCE DIRECTIVES END OF LIFE CARE PLAN OR DNR
NURSING ROLES AND RESPONSIBILTIES
ETHICAL DECISION MAKING PROCESS
The principles of doing “good” and not doing “harm” are the essence of every code of medical ethics. It is the duty of all medical professionals to their patients to exercise their professional skills in an ethical manner and to observe the laws of the community. The essential purpose is to ensure that the patients’ trust in the medical profession is deserved. This is achieved by protecting the patients and ensuring that they are able to obtain the maximum benefits available from the medicine. At the same time, the medical ethics aim to protect patients from the abuse that can occur when one person is in the position of power via-a-vis another
1. Cancer and its treatments can impact patient sexuality through biological, physical, and psychosocial factors like changes to the body, fertility issues, and emotional distress.
2. Nurses should conduct comprehensive assessments of patient sexuality through open communication, addressing cultural and personal factors, and utilizing models like PLISSIT.
3. Nurses can manage side effects on sexuality through treating symptoms, educating on intimacy options, and referring patients to supportive resources for physical and emotional wellbeing.
4. Nurses must overcome barriers like embarrassment through active listening, normalizing issues as treatable side effects, and focusing on holistic care of the patient's wellness.
The document discusses several ethical principles in healthcare including autonomy, beneficence, non-maleficence, and justice. It also reviews issues around patient competence, capacity, consent and best interests. Guidelines are provided around withdrawing treatment, Do Not Attempt Resuscitation orders, and considering a patient's wishes based on advance directives or views of family members when a patient lacks capacity.
Medical ethics is the discipline that deals with what we believe to be good or bad, right or wrong about the ends of Medicine and the means used to achieve those ends.
It is not about what we can do in a given set of circumstances. It is about what we should do in those circumstances.
Learning Objectives of this Presentation:
1. Appreciate the ethos of contemporary clinical ethics
2. Understand the function and responsibilities of ethics committees
3. Appreciate the clinical context of the core principles of medical ethics
4. Understand the relationship of ethics, science, law, politics, and professionalism
5. Examine different theories of ethics
Presentation by: Richard L. Wasserman, M.D., Ph.D.
Clinical Professor of Pediatrics
University of Texas Southwestern Medical School
2009
Do Not Resuscitate Orders : What They Mean ?SMSRAZA
Most doctors working in Acute areas know when and how to do CPR. However, most get stuck when it comes to ' When not to do CPR' due to cultural, social, ethical and legal issues attached.
Edição 166 do Diz Jornal, um jornal plural que aborda os mais variados temas desde internet, política, videogames até saúde e direitos do consumidor.
Acesse nosso site: http://dizjornal.com/
The ideal candidate for principal at Tacoma Baptist Schools will embody servant leadership and have a thoroughly biblical worldview. They will provide visionary leadership, foster instructional improvement by supporting student and teacher growth, and effectively manage the organization. Additionally, the candidate will practice inclusively in the community, model ethical leadership with zero tolerance for inappropriate behavior, understand the socio-political context, and manage perceptions by being available to all stakeholders. The position offers a competitive salary and benefits package that is on par with national averages for religious school administrators.
En 1913, el aviador francés Leoncio Garnier llegó a Las Palmas de Gran Canaria en un barco con su aeroplano Blériot XI desmontado. Lo montó en un improvisado aeródromo entre la torre de La Cicer y las fábricas de salazones de El Rincón. A pesar de que el mecánico Agustín Mañero se fracturó una mano, Garnier realizó varios vuelos sobre el norte de Gran Canaria antes de continuar sus exhibiciones en Tenerife.
Este documento describe tres ejemplos de factores de riesgo laborales comunes en diferentes industrias y cómo afectan la salud de los trabajadores. En una planta de cromado, los químicos utilizados pueden causar cáncer, quemaduras o pérdida de visión. En la construcción, los trabajadores están expuestos a materiales, alturas y condiciones climáticas que pueden causar fracturas, pulmonía o alergias. Finalmente, la recolección de desechos expone a virus, bacterias y plagas que pueden causar
This document outlines the schedule and learning objectives for a five-week career planning seminar. The seminar covers topics such as correlating majors to careers, experiential learning opportunities, using social media for career research and networking, resume writing, interview strategies, and professionalism. Students will learn self-assessment tools, how to conduct informational interviews and build social media profiles, and will develop a personal career action plan. Completing all sessions earns students a merit point and padfolio. The seminar aims to help students understand themselves and their career options through interactive exercises and assessments.
Lugol's solution is an aqueous solution of elemental iodine and potassium iodide. It was invented in 1829 by French physician J.G.A. Lugol and is used as an antiseptic, disinfectant for water, and reagent for starch detection. It has also been used to treat hyperthyroidism and replenish iodine deficiency. The solution turns dark blue/black in the presence of starches. It stains cell nuclei, glycogen in tissues, and mucogingival junction. Lugol's solution has various medical, laboratory, and aquarium applications and comes in concentrations of 1-5% iodine. Higher concentrations can cause irritation
Este documento presenta el reporte final de servicio social de una estudiante en el Servicio de Administración Tributaria (SAT). Describe las actividades realizadas por 6 meses en el área de recaudación, incluyendo analizar información financiera, organizar expedientes de contribuyentes, integrar nuevos documentos a expedientes, y apoyar con la presentación de proyectos y reportes. El reporte concluye detallando las habilidades adquiridas y la experiencia ganada al trabajar en una dependencia gubernamental clave.
This document summarizes the key details about education loans provided by banks in India. It covers topics like expenses covered by education loans, eligible loan amounts, repayment terms, interest rates and concessions, tax benefits, required documents, consequences of defaulting, advantages and disadvantages of education loans, and how loan terms differ between banks. The document provides information to help students understand and apply for education loans to fund their higher education goals.
This document defines antiseptics and disinfectants, and lists various antiseptic solutions. An antiseptic agent kills or inhibits the growth of pathogens on living tissue, while a disinfectant kills microbes on inanimate objects. Some common antiseptic solutions mentioned include weak iodine solution, phenol, hydrogen peroxide, spirit, povidone-iodine, formalin solution, and chlorhexidine gluconate solution. Details are provided on the composition, properties, and uses of selected antiseptic solutions.
1. DNA repair is a collection of processes by which cells identify and correct damage to DNA molecules to maintain the integrity of the genome.
2. There are several pathways of DNA repair including base excision repair, nucleotide excision repair, mismatch repair, non-homologous end joining, and homologous recombination.
3. Defects in DNA repair pathways can lead to increased mutations, cancer, and cell death if damage is left unrepaired.
The author installed Dobinsons MonotubeRemote Reservoir (MRR) shock absorbers and heavy-duty coils onto their 2009 Nissan Patrol. Over several trips through harsh Australian terrain, the suspension performed exceptionally well with no drop in performance. The suspension provided outstanding wheel travel and suspension flex, keeping the tires on the ground. The author highly recommends the Dobinsons MRR suspension setup as the best performing suspension they have ever used.
A brief presentation on the Medicolegal aspects of healthcare initially intended for the students - Post Graduate Diploma in Hosp. Management (Medvarsity)
This document outlines the steps involved in taxidermy, including preparing the hide and horns, measuring and positioning all features, detailing and sewing the hide, drying the animal, and finally painting it. The process involves carefully positioning the horns, eyes, ears, and other features on a base before detailing, drying, and painting the taxidermied animal.
This document discusses various topics in medical ethics including:
- The principles of medical ethics including compassion, competence, and patient autonomy.
- Oaths and codes of conduct that physicians must follow such as the Hippocratic Oath and the Declaration of Geneva.
- Approaches to ethical decision making and the role of organizations like the World Medical Association in establishing ethical guidelines.
- Issues involving patient relationships and informed consent.
- Ethical issues at the beginning and end of life such as abortion, euthanasia, and resource allocation.
- The importance of maintaining confidentiality and addressing conflicts of interest.
This document discusses various topics in medical ethics including:
- The definitions and origins of ethics, bioethics, and medical ethics.
- The key principles of medical ethics including compassion, competence, and patient autonomy.
- Oaths and codes of conduct that physicians must follow like the Declaration of Geneva.
- The role of the World Medical Association in establishing global standards in medical ethics.
- Approaches to ethical decision making and the principles of autonomy, beneficence, confidentiality, and justice.
- Ethical issues regarding informed consent, physician-patient relationships, beginning and end of life, resource allocation, and medical research.
The document outlines the code of conduct, marking system, course introduction, responsibilities, role, and ethics of physical therapists. Some key points include:
- Students must be on time, prepared, respectful and behave appropriately. Mobile phones are banned in class.
- The course will discuss the role, responsibilities, ethics, and accountability of physical therapists. It will also cover the change to doctoral-level education.
- As individuals, physical therapists must provide quality care, engage in ethical practice, and keep updated. They are also expected to be evidence-based and trustworthy clinicians.
- Ethical principles for physical therapists include respect for autonomy, nonmaleficence, beneficence, common good,
This document discusses several ethical issues that can arise in clinical practice, including maintaining patient confidentiality, providing accurate information to patients, dealing with terminally ill patients' end-of-life wishes, preventing sexual harassment, and addressing conflicts between personal and professional values or religious beliefs. It also examines ethical dilemmas that can occur when following one medical principle would require violating another. Specific topics covered include assisted suicide, human drug experimentation, and the role of institutional review boards in overseeing clinical research ethics.
Medical ethics deals with moral principles that guide clinical practice and relationships. It considers the choices and actions of both medical practitioners and patients in light of duties and obligations. There are several core principles of medical ethics including respect for patient autonomy, beneficence, non-maleficence, justice, confidentiality, and veracity. These principles guide informed consent processes and the patient-practitioner relationship. Upholding ethics is important for maintaining trust between the medical field and society.
PSYCHOLOGY LAW
PSYCHOLOGY LAW
PSYCHOLOGY LAW
Henry Mack
Grantham University
Veteran courts are courts designed to improve their experiences and give a second chance to people who have initially committed a crime. Instead of spending their lives in prison, veteran courts allow them to establish themselves, undergo a rehabilitation program and come out clean (Rodgers, 2018). Once one is assured of their changed behavior they are graduated and allowed to begin their lives on a new page. On the other hand, traditional court, had offenders punished for the mistakes they committed, jailed and serve in prison. Comparing the two types of courts, we appreciate the fact that the veteran court, allows those who have committed crimes to have a second chance in their lives (Ruff, 2018). Even though the traditional court is important in ensuring that there is more discipline and justice offered to the victim, by having the perpetrator, serve his sentence in prison.
Considering the offender, the veteran court system presents a better standpoint for them to ensure that they have a chance to recollect themselves, understand their source of problems and help in improving the behaviors that led them to commit a criminal act. The courts are advantageous to the criminals since they have a specialist who helps in assessing and treating mental health, drug abuse, and psychological issues (Rodgers, 2018). This specialist help in improving the conditions of their patients, by monitoring their behavior change and administering drugs to treat identified conditions. One could ask himself the following questions, why are you treating a villain, instead of imprisoning them?. The answer is simple. We are created to show love to other people, but not to extort the love they have outside them. This is unacceptable, veteran courts treat their patients with love and appreciation and upon completion of the stay, they are applauded and graduated, this allows them to come to the world and begin afresh.
The traditional court system could be unfair in disseminating their verdicts based on the offender. There have been cases where offenders are superimposed on an act that they did not commit. People have been arrested by the traditional system for being alleged of doing an offense, that in actual sense they did not commit (Ruff, 2018). In this case, there have been people who have been mistaken and jailed to serve a sentence they did not commit. This system is believed to be harsh on the offender, having the kind of treatment they receive while in prison. People who have gone through the traditional system, are likely to suffer from the post-trauma stress disorder. This disorder affects the psychology of the offender. There have been cases of inmates killing themselves due to depression. This happens because an individual is subjected to the harshest conditions.
In conclusion, comparing the two courts, the vet ...
Reexamine the three topics you picked last week and summarized. No.docxcatheryncouper
Reexamine the three topics you picked last week and summarized. Now, break out each case into a list of ethical and legal considerations that might help to analyze each case—summarize the considerations in two paragraphs for each case.
For each case, also ask one legal and one ethical question that might present. Consider the principles of ethics from Week 1 and the laws addressed this week. You should also use outside references to dig deeper into each case for your list.
3 topics identified in paper below from last week
· The Principal of Justice
· Autonomy
· Non-maleficence
Health Care Ethics
Health care ethics is a set of beliefs, moral principles and values that guide health care centers and related institutions to make choices with regard to medical care. Some health ethics include: respect for autonomy, justice and non-maleficence (Percival, 1849).
The principle of justice in health care ensures that there is respect for people’s rights, fair distribution of health resources and respect for laws that are morally acceptable. There are mainly two elements in this principle; equity and equality. Equity ensure that are all cases have equal access to treatment regardless of the patients’ status in ethnic background, age, sexuality, legal capacity, disability, insurance cover or any other discriminating factors.
It is important to study this ethical issue of justice since there have been an increasing report of doctors and medical staff failing to administer certain treatment services to certain kind of patients. Consequently, there have been debates in countries such as the UK over the refusal to give expensive treatment to patients who are likely to benefit from the treatment but cannot afford it. One ethical in the principle of justice is as to whether the health care center is creating an environment for sensible and fair use of health care resources and no particular type of patients are shun away or stigmatized. The legal question is whether the health care center is breaking the law against inequality and discrimination particularly racism, tribalism, gender insensitivity and other discrimination noted and prohibited in the country’s constitution.
The second area of health care ethics is respect for autonomy. Autonomy means self-determination or self-rule. Hence, this principle stipulates that one should be allowed to direct their health life according to their personal rationale. The patients have a right to determine their own destiny freely and independently as well as having their decision respected (Pollard, 1993).
This principle is important for study because not many people would not want to be treated as those with dementia; a disease involving loss of mental power. Many people are afraid of the prospect of not being able to decide their own fate and exercise self-determination. An ethical question in this principle of respect for autonomy is whether the health care center ensures that the patient is provided with ...
Medical ethics is important in the treatment of infectious diseases. It involves balancing moral principles like patient autonomy, beneficence, and non-maleficence. Conflicts can arise between what a practitioner thinks is best and what a patient wants. Practitioners must allow for patient autonomy while avoiding harm. They should also obtain informed consent, maintain confidentiality, and communicate openly with patients. Upholding medical ethics helps practitioners navigate difficult situations that arise during infectious disease treatment.
This document discusses several patient scenarios involving ethical considerations in healthcare. For Scenario 2, which involves a patient with advanced cancer in cardiac arrest, the advanced practice nurse must determine the patient's wishes regarding resuscitation and act according to ethical principles. For Scenario 3, involving a patient who cannot afford medications for Crohn's disease, the principles of justice and human rights to healthcare must be considered. For Scenario 6, involving an HPV vaccine for a 12-year-old patient whose religious family opposes it, the advanced practice nurse must balance ethical concepts, individual beliefs, and community health in decision making.
Assessment Should We Withhold Life The Martinez Case.docxbkbk37
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.
DQ 1 Response 1 As health care is advancing, there have been man.docxelinoraudley582231
DQ 1 Response 1
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.
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 .
This document provides an introduction to nursing ethics, covering key concepts and principles. It discusses the difference between ethical and legal standards, and outlines six main ethical principles - autonomy, beneficence, nonmaleficence, justice, veracity, and fidelity. It also examines concepts like paternalism, the doctrine of double effect, and different ethical frameworks. The document outlines nurses' rights in ethical situations and how to process ethical dilemmas. It addresses issues like withholding/withdrawing care, euthanasia, assisted suicide, and defining death. Throughout, it emphasizes putting the patient's needs and autonomy first in all ethical decision making.
Rose Barringer is a 74-year old woman with metastatic breast cancer who has undergone treatment for 10 years. She informs her oncologist that she is tired and does not want any further treatment. Her husband and some family members oppose this decision while her daughter in the medical field and some other children support her choice. Ethical principles of patient autonomy and paternalism are in conflict. Later, the family decides to make Rose DNR and she passes away comfortably, representing passive euthanasia given her disease progression led to her death.
The document discusses the tension between patient autonomy and paternalism in medical decision making. It explores different models of the patient-physician relationship and how the standard for informed consent has evolved from a professional to a patient-centered standard. Key concepts are that modern healthcare prioritizes patient autonomy, with competent adults having the right to refuse treatment, though some question if this has been taken too far in cases demanding futile care or pregnant women refusing testing.
Q 1 a providers obligation is to do no harm. healing the patientYASHU40
The document discusses recommending short-term acute rehab for a patient with difficulty walking due to mobility issues. Acute rehab facilities can provide intensive therapy programs tailored to the patient using specialized equipment to help them regain function quickly. Most insurances will approve rehab stays that meet admission criteria like participating in multiple therapies daily. Acute rehab is beneficial for safely restoring patients to their prior levels of functioning and reducing risks of falls or injuries from prolonged decreased mobility.
Ethical PrinciplesEthics are guided by the core principles to wh.docxgitagrimston
Ethical Principles
Ethics are guided by the core principles to which most of our society agree. The devil is in the details, however, as we will see in specific instances.
Autonomy
The principle of autonomy ties into patients' rights to self-determination, or the right to make their own fully informed choices about their care; treatments they may accept or reject; and the ultimate consequences of their choices. The freedom to choose our own course of action is highly cherished in our society. However, what if the choice involved taking a life, whether by suicide or homicide? What happens when one person's desires or choices bump up against another's? These gray areas are the turf on which ethical issues play out. An example of an ethical dilemma surrounding autonomy occurs when a patient denies a lifesaving medical treatment. What if the person refusing treatment is legally a child who refuses chemotherapy for a curable cancer, all because of religious beliefs? Does the child know that without treatment death is likely? Does the child understand death well enough to make the choice? What if the parents are making this choice on behalf of their child, which is often the case? Does the principle of autonomy extend to treatments that are curative and life-saving, yet conflict with deeply held religious or personal beliefs? What role should government play in order to protect its citizens, even from themselves? Autonomy can be a minefield of conflicting values, views, and actions.
Beneficence
The principle of beneficence requires that all actions taken on behalf of a patient are designed to provide good outcomes. Seem obvious? Focus on the question of what constitutes a "good outcome." A 76-year-old man has fallen on ice, struck his head, and has suffered severe brain damage from the resultant bleeding into the brain. He is still able to respond to painful stimuli, breathe on his own, and maintain blood pressure and other bodily functions. However, the cerebral cortex is permanently damaged. The family and the physician huddle to discuss what steps to take next. What is the beneficent approach? It is possible to sustain life in this patient since his brain stem is intact and he does not meet the criteria for brain death. Should he be given fluids and nutrition through tube feedings? If he develops pneumonia, should it be treated? Should he be left alone with minimal comfort measures to see what his body will do as the injury unfolds? Should all interventions be withheld? Would it do the patient more harm to continue all measures, or to stop all measures? What are the patient's wishes, as expressed by his surrogate, in a situation such as this? Beneficence can be a tricky concept, since what is helpful and indicated in one situation may be a terrible choice in another. The question of the definition of "good outcome" may be wildly different from various perspectives of the family, the physicians, the patient himself, and the hospital.
Non-malfe ...
Ethics presentation given at Providence Health Care on 2/19/16 as a part of a day-long nursing oncology conference. Discusses the fundamental clinical ethics consultation approach and discusses in narrative the relevant ethics cases that are common to oncology practice
Medical ethics provide moral principles to guide physicians in their practice and dealings with patients. The document discusses key concepts in medical ethics such as autonomy, beneficence, non-maleficence, and justice. It also covers international guidelines like the Declaration of Geneva and the International Code of Medical Ethics. The code outlines the duties physicians have to patients, other doctors, and in general, including maintaining confidentiality, acting with integrity, and providing competent care. Unethical practices like improper advertising or fee splitting are also described.
1. RUNNING HEAD: ADVANCED CANCER PATIENT’S WISHES AT END-OF-LIFE 1
Case Presentation:
Janice Keller is a 62-year-old white female who was diagnosed with Non-Hodgkin’s
Lymphoma in February of 2011. She and her husband had recently retired and were planning
their retirement together. She was in perfectly good health before she was ill. Janice’s battle with
cancer got increasingly worse over a four year period. She was receiving chemotherapy and
radiation treatments. In the last year of her illness, Janice began getting very sick and very
confused. Her husband took her to the Emergency Room many times for confusion and
dehydration.
The patient began her diagnosis stating she was determined to beat the cancer. The cancer
Center Social Worker met with the patient and her husband throughout her treatment. She denied
depression and stated she was motivated to complete treatment and “move on with life.” Janice’s
family was very supportive and her husband was able to attend all of her appointments. During
the final year of her life Janice stated that she was having “more bad days than good” (Hospital
Chart, 2015). She also stated that she was not coping with her diagnosis. The Cancer Center
Social Worker offered the couple counseling services, support groups, and in home services but
they declined help. Two months before Janice passed, her husband expressed his concerns. He
stated that his wife had “given up” (Hospital Chart, 2015). He shared that Janice had lost
functioning and independence but that he was hopeful Janice would “come out of this” (Hospital
Chart, 2015). Janice’s husband also shared his fears that she would not recover.
Janice’s nurses also noticed her declining happiness. One nurse’s note at the beginning of
the month that the patient passed stated that she was not doing well. The nurse wrote that
“patient appears withdrawn, no eye contact made, when asked how patient doing, no response,
head held low and started crying, patient husband stated ‘she’s given up, she doesn’t want to
2. ADVANCED CANCER PATIENT’S WISHES AT END OF LIFE 2
drink or eat or do anything anymore’ offered support, words of encouragement, no response from
patient” (Hospital Chart, 2015).
The patient’s statement of incapacity was signed and her medical power of attorney was
activated on October 21st. This means that her husband became her medical decision maker. This
was activated due to her persistent confusion. Although, Janice did experience periods of
coherence, she was not able to make her own medical conditions.
The patient’s condition was becoming much worse during the time her husband was
named the medical decision maker. Janice was physically sick and looked very discolored,
withdrawn, and frail. She had made many statements that she was done fighting and wanted to
stop treatment. Her husband was very visibly upset by these statements. Her husband wanted her
to continue treatment even thought this treatment was not curative. Meaning, for her condition,
any treatment would just prolong life and not cure the cancer. The patient had expressed wanting
to end treatment but her husband, who is her medical decision maker, wanted her to keep
fighting.
The medical team noticed this discrepancy between what the patient wanted and what the
medical decision maker was doing. The patient’s doctors and nurses conducted family care
meetings with the patient and her husband to make sure that he was making the best choices for
the well-being of the patient.
If the patient’s husband could not come to a decision that was in the best interest of the
patient, the hospital’s ethical committee would have to meet. Presented below is the ethical
dilemma and the decision making that would have occurred if the patient’s husband continued to
force the patient to do treatment against her desires.
Ethical Dilemma Versus Statement:
3. ADVANCED CANCER PATIENT’S WISHES AT END OF LIFE 3
Therefore the versus statement associated with this ethical dilemma is:
Client Self Determination and Quality of Life VS. The Legality of
the Medical Power of Attorney.
Ethical Decision Making Model:
To examine the ethical dilemma properly, an ethical decision making model will be used.
Ethics is a branch of philosophy and draws from broader philosophical theories in order to
formulate concepts. Ethical decision making theories were developed to address broad, often
ambiguous issues. While of the ethical decision making concepts differ in some way, they all
consider the value and worth of the human, dignity of life, and the role of happiness, however
this is defined (Rothman, 2013). The most applicable ethical decision making models for this
case are Reamer’s Application of Gawith’s Principles of Hierarchy and Dolloff, Liebenberg, and
Harrington’s Ethical Principles Screen that gives primacy to the NASW Code of Ethics
(Rothman, 2013). This section will analyze the case’s ethical dilemma using both ethical
decision making models.
Reamer’s Application of Gawith’s Principles of Hierarchy:
Reamer bases this model on his interpretation of Alan Gawith’s Principles of Hierarchy,
created in 1994. The hierarchy of principles is based on the fundamental right of all humans to
freedom and well-being (Gawith, 1978, pg. 59-65). Reamer proposes that there are three
categories of core goods that enable or enhance these rights. Basic goods, which are necessary to
well-being, include food, shelter, life, health, and mental equilibrium. Non subtractive goods, the
loss of which would seriously compromise fundamental rights, such as honesty and fidelity in
individual relationships, reasonable labor and comfortable living conditions. Finally, additive
goods, which increase or enhance well-being, such as education, self0esteem, and material
wealth (Rothman, 2013).
4. ADVANCED CANCER PATIENT’S WISHES AT END OF LIFE 4
In Reamer’s ethical decision making model, there exists six principles of hierarchy.
According to Reamer, the ethical dilemma should be evaluated by analyzing the issue through
principle one and so on. Principle one constitutes rules against basic harms to the necessary
preconditions of action (the core goods, food, health, shelter, etc.) and how these take precedence
over rules against harms such as lying, revealing confidential information (nonsubstractive
goods), or threats to additive goods such as education, recreation, and wealth (Rothman, 2013).
In the case at hand, the condition of the patient’s health or health quality of life take precedence
over other harms such as harming the self-esteem or mental stability of the husband.
Principle two includes that an individual’s right to basic well-being (core goods) takes
precedence over another individual’s right to well-being (Rothman, 2013). Janice’s right to her
basic well-being or desire to end treatment in favor of quality of life vs. quantity takes
precedence over the husbands right to well-being.
Principle three is an individual’s right to freedom and how that takes precedence over his
or her own right to basic well-being (Rothman, 2013). Janice’s right to her freedom, in this case
to choose her end-of-life decisions takes precedence over her right for well-being. In this case,
Janice has the right of freedom of choice when it comes to end-of-life, even if this choice is to
quit treatment.
Next, principle four, is the obligation to obey laws, rules, and regulations to which one
has voluntarily and freely consented ordinarily and how that overrides one’s right to engage
voluntarily in a manner that conflicts with these laws, rules, and regulations (Rothman, 2013). In
this case, Janice is to obey laws and rules of society. The hospital must respect the legal authority
of the power of attorney for medical.
5. ADVANCED CANCER PATIENT’S WISHES AT END OF LIFE 5
Principle five states that the individual’s rights to basic well-being may override laws,
rules, regulations, and arrangements of voluntary associations in cases of conflict (Rothman,
2013). Conversely, the patient has the right to wellbeing despite laws and rules of society.
Therefore, the patient has the right to quality of life in end-of-life despite the wishes of the legal
medical power of attorney.
Finally, principle six states that the obligation to prevent basic harms such as starvation
and to promote basic public goods such as housing, education, and public assistance overrides
the right to retain one’s own property (Rothman, 2013). This indicates that there is an obligation
to prevent basic harms of the client. In this case, a basic harm of the patient is to continue
treatment, which is painful and not curative and against the desires of the patient. The social
worker and hospital staff have an obligation to try and prevent this.
Therefore, according to this ethical framework, the social worker should advocated for
the least harm of the patient despite possible harms to others around her. While the medical
power of attorney should be honored, it does not stop the social worker and hospital staff from
advocating for the client’s well-being and end-of-life desires.
Dolgoff, Loewenberg, and Harrington’s Ethical Principles Screen: Primacy to the NASW
Code of Ethics:
The Dolgoff, Loewenberg, and Harrington’s Ethical Principles Screen gives primacy to
the NASW Code of Ethics. The process induces identifying the problem, and the people,
organizations, and agencies involved, determining the values, goes, and objectives relevant to the
issue held by all who are involve, developing and accessing alternative courses of action,
selecting the most appropriate, and implementing it. If there are relevant sections of the Code
that can provide direction, these must be used. If there are no relevant sections, or if different
sections of the Code give conflicting directions, social workers should apply the Ethical
6. ADVANCED CANCER PATIENT’S WISHES AT END OF LIFE 6
Principles Screen, which prioritizes seven principles to guide decisions (Rothman, 2013). There
are seven guiding principles in this ethical decision making model. Principle one speaks of the
protection of life. Biological life must always take precedence over any other principles, because
it is in the context of life that ethical decisions are made (Rothman, 2013). In this case, the social
worker and hospital staff are advocating for quality of life at end-of-life. In this way, they are
advocating for quality biological life.
Principle two addresses equality and inequality. Similar circumstances and situations
should be treated the same. However, if there are relevant significant differences, these should be
taken into consideration, and unequal treatment may be accorded where it would lead to greater
equality (Rothman, 2013). When looking at similar situations in practice and in the public
sphere, most individuals advocate for quality of life at end-of-life vs. prolonged, sometimes
painful, life at end-of-life.
Principle three reports on autonomy and freedom. Clients’ autonomy and self-
determination should always be considered, unless their autonomous actions and choices would
threaten the life of self or other. The right to freedom, however, is less compelling than the
prevention of harm or death (Rothman, 2013). Janice has the right to autonomy and freedom of
choice as long as her choices are not harmful to herself or others. Janice wished to end treatment
early which could be seen as a harmful act towards herself. Although, this act could be seen as
her freedom to choose. This is a choice the prevents the further harm of herself by treatment and
allows for quality of life at end-of-life with appropriate hospice care.
Principle four advocates for the least harm. Social workers should avoid causing harm
and prevent harm from occurring to clients or others. Where harm is unavoidable, social workers
should choose the course of least harm, or most easily reversible harm (Rothman, 2013). In this
7. ADVANCED CANCER PATIENT’S WISHES AT END OF LIFE 7
case, physical harm could occur to the patient if she is forced to continue treatment. While,
psychological harm may occur to the husband if he decides to discontinue treatment for his wife.
Although harm in this situation is unavoidable, the option for least harm and maximum patient
autonomy would be to follow the wishes of the patient and end treatment.
Principle five supports quality of life. Enhancing quality of life for clients and others in
society should be a goal of social work interventions (Rothman, 2013). As stated previously, the
best quality of life for the patient would be to end treatment and return home with hospice care.
In this way, the patient’s wishes are honored and she is made as comfortable as possible with
family present.
Principle six speaks of privacy and confidentiality. There right to privacy of clients and
others should be enhanced wherever possible and in accordance with laws. However, it may be
necessary to break confidentiality when serious harm or death to clients or others may result
from maintaining such confidentiality. Finally, principle seven addresses truthfulness and full
disclosure. Social workers should be honest and provide full and truthful information to clients
and others in order to support a relationship grounded in trust and honesty (Rothman, 2013).
Through this ethical dilemma framework it can be assessed that the best course of action
would be to honor the wishes of the patient. Although harm could occur to the patients husband,
this would be the least harmful with maximum client autonomy for the patient. Therefore, the
social worker and hospital staff should continue to advocate for the patient’s wishes to end
treatment early.
NASW Code of Ethics:
In addition to utilizing Dolgoff, Loewenberg, and Harrington’s ethical decision making
model that gives primacy to the NASW Code of Ethics, it is important to look directly at where
8. ADVANCED CANCER PATIENT’S WISHES AT END OF LIFE 8
the NASW stands on this ethical dilemma. The ethical dilemma at hand can be categorized as an
end-of-life issue. The NASW “does not take a position regarding the myriad moral and value-
laden questions associated with end-of-life decisions, but affirms the right of individuals to direct
their end-of-life care” (NASW Delegate Assembly, 2006). Therefore, the NASW does not take
an official stance on the ethical decisions that occur in end-of-life care but advocates for client
self-determination. The NASW states that “choice should be intrinsic to all aspects of life and
death. Social workers have an important role in helping individuals identify the end-of-life
options available to them” (NASW Delegate Assembly, 2006). Therefore, the NASW supports
that social workers are to keep intact client self-determination and give patients all of the options
available to them at end-of-life.
In addition, the NASW Code of Ethics supports values that should be taken into account
during this case. The Code of Ethics values the importance of human relationships. In this case,
the value of a strong and supportive relationship between the patient and her husband is essential
for her wellbeing. In addition, the NASW Code of Ethics values the dignity and worth of each
person. In this case, the social worker should protect Janice’s self-determination even though she
is technically incapacitated and to strive for the least harm to the client (NASW Code of Ethics,
2008).
The NASW also describes certain “action steps” that social workers can take when
dealing with end-of-life issues. Specific actions steps that are relevant to this case are; to
facilitate client and family understanding of all aspects and options in end-of-life care, provide
emotional, psychological, social, and spiritual care and services along the end of-life continuum,
provide access to information to facilitate informed consent for decision making, be aware of
client diagnoses and trajectories of illness to best prepare for future health care needs and
9. ADVANCED CANCER PATIENT’S WISHES AT END OF LIFE 9
decisions, discuss and encourage advance care planning if appropriate, strive to facilitate
continuity of care across all care settings, be knowledgeable about institutional policies on
capacity, advance directives, pain management, futile care, and DNR orders, be able to
differentiate between pain and existential suffering, and act as a liaison with other health care
professionals to communicate clients’ and families’ concerns to the health care team to improve
the quality of end-of-life care (NASW Delegate Assembly, 2006).
The social worker and hospital staff in this case took all of the action steps as suggested
by the NASW. The hospital staff and social worker conducted family care conferences to
facilitate understanding of the options in end-of-life care. Support, access to information, and
listening was provided at all steps of the process. The social worker and hospital staff followed
the NASW Code of Ethics’ suggestions when dealing with this case.
Current Research:
When analyzing an end-of-life ethical dilemma, like the case at hand, it is important to
seek guidance not only from ethical decisions making models and the NASW Code of Ethics but
existing research. In an article from the Cancer Network, researchers Tenner and Heft present
three cases that are intended to prepare practicing oncologists to confront common ethical
dilemmas. The cases they present are when costs of care may be prohibitive for the patient, when
a conflict arises between the patient’s and the family’s preferences for prognostic information,
and when a crucially ill patient with cancer becomes unresponsive and the family is forced to
make the care decisions. It is important to note that Tenner and Heft cite end-of-life decision
making as an important and common ethical dilemma in oncology practice making it even more
beneficial to analyze this case in order to have an understanding for future cases (Peppercorn,
MD, MPH, 2013).
10. ADVANCED CANCER PATIENT’S WISHES AT END OF LIFE 10
According to the researchers, patients with advanced cancer facing end-of-life appreciate
realistic conversations. Data has shown that patients expect frank discussion of prognosis and
goals of care (Peppercorn, MD, MPH, 2013). These discussions can often change the way the
care is delivered, moving towards greater emphasis on palliative care (Peppercorn, MD, MPH,
2013). Realistic discussions of prognosis are needed early in care to avoid later complications at
end-of-life.
In the case at hand, Janice, her husband, and her care team discussed end-of-life planning
early in her treatment and continued to keep open channels of communication throughout her
treatment. At the hospital, a social worker explains an advance directive during the initial
evaluation of the patient. Patients are encouraged to fill out the medical power of attorney and
living will early on in their treatment to ensure that their wishes will be honored. Janice filled out
the medical power of attorney and the living will early on in her treatment. Janice named her
husband as her power of attorney and decided that she did not want extensive life saving
measures, no feeding tubes, and no ventilators. Janice later signed a do not resuscitate order
which states that no extensive life saving measure will be used if she became unresponsive.
Continued frank and clear discussions of prognosis continued throughout Janice’s treatment.
Although, throughout this process it appeared that her husband did not process the discussions as
fast as Janice did. In these ways, the hospital staff took preemptive measures to ensure that
Janice’s wishes would be honored.
In regards to ethical decision making at end-of-life, Walker, MD, cites four types of legal
cases that exist. These legal cases are (1) the patient with decision-making capacity, (2) the
patient without capacity but who had earlier expressed treatment preferences for end-of-life care
either verbally or in a written advance directive document, (3) the patient without capacity who
11. ADVANCED CANCER PATIENT’S WISHES AT END OF LIFE 11
had made no prior expression of treatment preferences, and (4) the patient who never had the
capacity to make treatment decisions (Walker, MD, n.d.).
In this case, Janice is considered to be in classification two; the patient is currently
without capacity but had earlier expressed her treatment preferences. In these cases, courts have
ruled that their advance directive wishes should be followed. This is in opposition to the desires
of the appointed medical power of attorney. According to this author’s research, when a
discrepancy arises between the patient’s pre-made end-of-life wishes and the power of attorney’s
current wishes, the court rules in favor of the patient’s end-of-life wishes (Walker, MD, n.d.).
Therefore, if Janice’s husband had continued to want Janice to undergo treatment, her case could
have been taken to court where the court would most likely rule in favor of Janice’s pre-made
wishes regarding end-of-life.
Applicable Case Law:
In addition to current research regarding of end-of-life ethical dilemmas, it is important to
understand the case law relating to these ethical dilemmas and how the right to deny or stop
treatment came to be.
Living Wills and Right to Stop Treatment:
The very first U.S. court case to deal with the issue of end-of-life care was the matter of
Karen Ann Quinlan, a 1976 New Jersey state court case. This cases was used to advance the idea
of Living Wills, by which citizens could authorize their own end-of-life wishes. On April 15,
1975, Karen Ann Quinlan, collapsed, stopped breathing, and slipped into a coma. She had just
arrived home from a party where her friends reported that she took prescription drugs and drank
alcohol after not eating for several days. Doctors were able to save her life, but she suffered
severe brain damage and fell into what doctors diagnosed as a persistent vegetative state. Ms.
12. ADVANCED CANCER PATIENT’S WISHES AT END OF LIFE 12
Quinlan was thought to be unable to breathe without a mechanical device and she was unable to
eat without a feeding tube (National Center for Life and Liberty, 2015).
After months with no progress, Ms. Quinlan’s family saw no hope for recovery and they
did not want to keep her alive artificially. Her father, who had been appointed guardian, asked
the doctors to remove Ms. Quinlan’s ventilator, but the hospital refused after being warned that
prosecutors could bring homicide charges against them. Ms. Quinlan’s doctors refused to remove
her life support without a court order to protect them. As a result, Ms. Quinlan’s family went to
state court seeking legal protection for the hospital to remove their daughter’s ventilator, where
they won their case (National Center for Life and Liberty, 2015).
In its decision, the New Jersey Supreme Court cited to Roe v. Wade, which had been
decided by the U.S. Supreme Court only three years earlier and had established that every person
has a general constitutional “right to privacy” with regard to medical issues. The New Jersey
Supreme Court ruled that this “right to privacy” was “broad enough to encompass a patient's
decision to decline medical treatment under certain circumstances in much the same way as it is
broad enough to encompass a woman's decision to terminate pregnancy…” (National Center for
Life and Liberty, 2015).
The court held that a competent patient has a constitutional right to choose whether to
accept or discontinue life-prolonging medical treatment. Since Ms. Quinlan was no longer
competent to make this choice for herself, and she had not made this choice while she was still
competent, the court ruled that her incompetence was not an acceptable basis for depriving her of
a constitutional right to refuse medical treatment and die. Therefore, the court permitted her
guardian to make that decision on her behalf (National Center for Life and Liberty, 2015).
Impact of Case Law:
13. ADVANCED CANCER PATIENT’S WISHES AT END OF LIFE 13
This case illustrates how the right to stop treatment came to be. Although this case is
more drastic than the case at hand they deal with the same ethical dilemma; right to decide end-
of-life care. In this case, Janice indicated per a living well before she was mentally incapacitated,
that she did not want extraordinary measures taken if her death was imminent or if she was in a
persistent vegetative state. Current case law states that Janice’s wishes should be honored and
that if she chooses to end treatment and die, that the hospital staff is not liable for her death.
Although Janice is incapacitated at the end of her life, she still made the decision prior to
not have extensive medical interventions done. Therefore, the hospital staff should work to honor
the decisions of the client. This means that although the patient’s power of attorney wants her to
continue treatment, the hospital staff is responsible for the patient and should protect the
patient’s right to self-determination by honoring that patient’s end-of-life wishes. In regards to
current case law, the hospital staff should try to help Janice’s husband advocate for the wishes of
Janice even if they contradict his wishes.
Current Cases in the News:
Since issues surrounding end-of-life decisions is relatively new, there exist a plethora of
cases in the public news. These cases are important to research to see the public’s opinion of
stopping treatment and to hypothesize possible reactions of the patient’s family and friends.
Children and Teens Refusing Treatment:
In 2015, a 17 year old Connecticut teenager refused chemotherapy treatment for her
Hodgkin’s Lymphoma that had an 85% creative rate. The family wanted to search for alternative
treatments but a judge ordered the teenager to undergo chemotherapy. After two treatments the
teenager ran away from home and was later put into protective custody. The teenager’s mother
stated that it was her decision to refuse treatment, “she does not want the toxins. She does not
14. ADVANCED CANCER PATIENT’S WISHES AT END OF LIFE 14
want people telling her what to do with her body and how to treat it…They are also killing her
body. They are killing her organs. They're killing her insides. It's not even a matter of dying.
She's not going to die.” The Connecticut Department of Children and Families stated that they
have expert testimony stating that the teenager would die in two years if she does not undergo
chemotherapy treatment. The teenagers lawyer argued for the “mature minor doctrine” which
allows which allows 16- and 17-year-olds in some states to get a judge's permission to make
medical decisions for themselves. But, the court said the patient had not proven mature enough
or competent to make those decisions, citing the fact that she had run away from home (Briggs,
2015).
In this case, the teenager wanted to refuse treatment but was unable to do so as she was a
minor. The courts and child protective services have more authority to hold a person against their
will to complete treatment. If this patient was an adult, it can be assumed that the patient would
have been able to make her decision and refuse treatment. This case upholds current case law
stating that adults can refuse treatment if they are competent to make the decision. Since the
child was not an adult child protective services can intervene to do what is best for the child.
Another current case involves a 50 year old mother of three from London who refused
kidney dialysis treatment because she did not want to “lose her sparkle” and become “poor, ugly
or old.” The court in London heard the case after the patient tried to overdose to take her own
life. The patient’s hospital wanted the judge to rule that it would be in her best interests if
treatment was imposed and restraint was used if necessary. The court decided that the woman
has the mental capacity to refuse treatment. A court spokesperson stated that “Her decision is
certainly one that does not accord with the expectations of many in society…Indeed, others in
society may consider her decision to be unreasonable, illogical or even immoral within the
15. ADVANCED CANCER PATIENT’S WISHES AT END OF LIFE 15
context of the sanctity accorded to life by society in general…None of this, however, is evidence
of a lack of capacity” (Clarke-Billings, 2015).
According to this current case, the patient was able to make her own decision regarding
her care even if it was contrary to popular beliefs. Also, this case upholds that notion that adults
can make their own decisions regarding treatment and ending treatment as long as they are of
sound mental capacity.
Finally, a very recent and public case regarding the right to end treatment involved two
country singers couple. Joey and Rory Feke are a couple and up and coming country stars with a
large fan base. Joey, the women, has been battling cancer for a long time. Her cancer came back
and she underwent extensive surgery and chemotherapy. The therapies were not working as a CT
scan revealed two tumors in areas already treated by chemotherapy and radiation. In a statement
made via their blog the couple shared, “So we did what you do when the medicine isn’t working,
and the doctors are at a loss…and when the ‘statistics” say you can do more chemo, but it will
only buy you a little time…We came home. Not to die. But to live” (Whitaker, 2015). The
country couple is very faithful and put their trust and faith in God stating that they “prepare for
what God has put in front of us…” (Whitaker, 2015).
This current case is most similar to the case at hand. Janice and Joey are both facing
advanced cancers with treatments that are not working. Both could continue treatment to “buy
more time” but the treatment is palliative, not curative. Joey was of sound mind and made the
decision to end treatment and be home with hospice care. Janice was not of sound mind but had
made comments about how she was “done” with treatment. Janice also had indicated in her
living will that she did not want extensive measures taken if her death was imminent. Although
16. ADVANCED CANCER PATIENT’S WISHES AT END OF LIFE 16
this does not specifically state she wanted to stop treatment, it eludes to the fact that, if she was
of sound mind, she would not want to continue with aggressive treatments.
Societal Values:
From observations of current and past publicized cases like Janice’s case, society’s
opinion of this ethical dilemma is varied. For example, society majorly disapproves when a
person is taken off of life-support or a ventilator and consequently passes away (National Center
for Life and Liberty, 2015). Conversely, society is more accepting and sometimes sees it as
honorable that a person decides to end treatment early (Whitaker, 2015). In Janice’s cases,
society would be accepting of her and her husband’s decision to end treatment early.
Agency and Staff Values:
Mission, Vision, Values of Hospital System:
The hospital’s mission statement is “committed to living out the healing ministries of the
Judeo-Christian faiths by providing exceptional and compassionate healthcare service that
promotes the dignity and well-being of the people we serve” ([The Hospital], 2004). The vision
statement states “The health ministries of [the hospital] will be recognized in each community it
serves for superior and compassionate patient service, for clinical excellence, and for being the
healthcare employer of choice and the preferred partner of physicians” ([The Hospital], 2004).
The hospital also promotes shared values that are to bring to live the mission. These
values are: “integrity; we are consistent and honest in word and deed, respect; we behave in a
way that honors self and others, quality, we provide service excellence in meeting customers’
expectations, Commitment; we demonstrate dedication to our work, personal development, the
organization, the mission and the vision, and accountability; we follow through and are
answerable for our performance” ([The Hospital], 2004).
17. ADVANCED CANCER PATIENT’S WISHES AT END OF LIFE 17
The mission and vision statement and the values dictated how the hospital approaches
patient care and ethical dilemmas like present in this case. When creating hospital policy, each
policy begins with how the subsequent policy will address and uphold the mission, vision, and
values of the hospital. The mission, vision, and values are also instilled into new employees
during employee orientation. The hospital system places a high value on following the mission,
vision, and values from administration to patient care ([The Hospital], 2004).
Catholic Church Affiliation:
The hospital is affiliated with the Catholic Church. Although, this affiliation does not
prohibit members of other faiths from receiving the same quality of care as others. Nevertheless,
the Catholic Church is still affiliated with the hospital and it is therefore necessary to analyze
where the Catholic Church stands on end-of-life issues (Catholic Health Association of the
United States, n.d.).
Most of the knowledge base of the stance of the Catholic Church on these issues comes
from the Ethical Directives for Catholic Health Care Services. This is a document which guides
the practice of Catholic affiliated hospitals, long term care facilities, and other Catholic health
care organizations. According to this and other documents, the Catholic Church affirms that
there is a long standing moral theology that speaks of “reasonable care in terms of the benefits of
such treatments being proportionate to the burdens that the treatments impose.” The Catholic
Church offers two extremes to avoid regarding end-of-life issues; intending the death of a patient
by assisted suicide and continuing useless or excessively burdensome treatments. The Catholic
Church advocates for a middle ground on these issues (Catholic Health Association of the United
States, n.d.).
18. ADVANCED CANCER PATIENT’S WISHES AT END OF LIFE 18
The term “burden” is defined by the Catholic moral tradition as having four aspects. They
are excessive pain, great cost or means to the patient, grave effort excreted by the patient, and an
intense fear or repugnance for the treatment may make an ordinary treatment an extraordinary
treatment for certain patients (Catholic Health Association of the United States, n.d.).
The Catholic Church states that one has the duty to preserve life but this duty is not
absolute. In the Vatican’s 1980 document entitled Declaration on Euthanasia Part IV states that
“one cannot impose on anyone the obligation to have recourse to a technique which is already in
use but which carries a risk or is burdensome? Such a refusal is not the equivalent of suicide; on
the contrary, it should be considered as an acceptance of the human condition” (Catholic Health
Association of the United States, n.d.).
Therefore, the Catholic Church, which is affiliated with the hospital, advocates for a
middle ground between assisted suicide and excessive treatment that creates undue burden for a
patient. In the current case, Janice’s husband could be considered to be putting his wife under
undue burden or excessive treatment for Janice’s terminal cancer. The Catholic Church would
support Janice’s pre made decision to not utilize drastic life-sustaining measures.
Perceived Values of Cancer Center Staff:
The Cancer Center staff at the hospital also share common and unique values. The overall
value system of the Cancer Center is that of patient centered care and patient self-determination.
The doctors, nurses, social workers, and other Cancer Center staff advocate strongly for the
physical, mental, and emotional health of each patient. In addition, the radiation oncologist is
very determined to have every patient understand and fill out an advance directive and living
will. Some members of the staff are religious; mostly all are of the Christian faith. The author
has not yet observed that this has impacted the type of care that is given to each patient. The faith
19. ADVANCED CANCER PATIENT’S WISHES AT END OF LIFE 19
background of the staff does not appear to influence the practice. The values held by the staff
patient self-determination and overall quality of life.
Personal Values:
The author holds values that are similar to the values held by the NASW. The author
values client self-determination and well-being. The author values the overall quality of life of a
patient over the quantity of life. In this way, the author agrees with and values the desire to end
treatment early and to live the rest of one’s life with quality and family near.
Client and Family Values:
The patient was a recently retired wife and mother. The patient and her husband were
planning to travel and enjoy retirement together but she was diagnosed with cancer soon after her
retirement. The family indicated that they were Catholic but they were not strictly religious or
very active in the church. The family was spiritual in that they believed in God and life after
death. The patient’s husband had a difficult time accepting the severity and immediacy of his
wife’s condition. This appeared to be the biggest obstacle in helping the patient’s end-of-life
wishes is honored. The patient valued the life of his wife and their relationship. He loved her
very much and truly wanted to do what was best for her.
Options for Action:
Option One: Continued Family Care Conferences:
The first option for action in this case would be to continue the family care conferences
with the patient, husband, and hospital staff. Family care conferences are requested by the family
or the hospital staff. The family and all concerned staff are involved for a conversation about the
patient’s diagnosis, prognosis, and quality of life. The hospital staff had already completed
several care conferences by this time. More care conferences would help the husband work
20. ADVANCED CANCER PATIENT’S WISHES AT END OF LIFE 20
through his grief and the severity of his wife’s diagnosis; helping him to see what is really in her
best interest. Conversely, these family care conferences could continue to produce no new
decisions from the husband. In this way, the patient would continue treatment that she did not
desire to do.
Option Two: Ethics Committee Intervention:
Since the family care conferences were not yielding new decisions from the husband, the
hospital ethics committee could become involved. An ethics committee consultation serves the
purpose to “identify bioethical problems in the care of a particular patient, to analyze these
bioethical problems through careful dialogue, and to facilitate resolution of bioethical problems
through a process of shared decision making with those most involved.” A request can be made
from the family member or the hospital staff involved. This can be done in an informal or formal
matter and those it concerns are not obliged to participate. The purpose of the ethical committee
consultation is to provide guidance on how to deal with a particular ethical dilemma.
The hospital staff involved could request an ethical consultation to help them decide how
to handle the patient’s ethical dilemma. In addition, the ethical consultation could be requested
by both the family and the hospital staff to discuss the situation and, hopefully, come to a
resolution.
This option for action provides more structure and additional hospital staff to provide
guidance on the ethical dilemma. This may signal to the patient’s husband that her situation is
dire and he must act for the well-being of the patient. Conversely, the addition of more hospital
staff may upset the patient and her husband. The husband may feel that he is being scolded or
being told he does not know how to care for his wife. This may make the husband more upset
and keen to follow what he thinks is best for the patient. This solution could hinder the
21. ADVANCED CANCER PATIENT’S WISHES AT END OF LIFE 21
relationship with the husband and further push him to do what he thinks is best for the patient
(continue treatment). Or, this solution could signal to the husband that his wife’s condition is dire
and to do what she desires and end treatment.
Option Three: Legal/Court Intervention:
According to Walker, MD, four types of legal cases regarding end-of-life ethical decision
making exist. One of these legal cases is when the patient is without capacity but had earlier
expressed treatment preferences for end-of-life care either verbally or in a written advance
directive document. In these cases, courts have ruled that their advance directive wishes should
be followed. This is despite the desires of the appointed medical power of attorney. According to
this author’s research, when a discrepancy arises between the patient’s pre-made end-of-life
wishes and the power of attorney’s current wishes, the court rules in favor of the patient’s end-
of-life wishes. Therefore, if Janice’s husband had continued to force Janice to undertake
treatment her case could have been taken to court where the court would most likely rule in favor
of Janice’s pre-made wises regarding end-of-life.
Therefore, the hospital staff has the option of taking Janice’s case to court to contest the
power of attorney. This option is very drastic and would most likely harm the existing
relationship with the husband. This would cause undo harm on the psychological well-being of
the husband. In addition, this would be a very time consuming process which would likely not
resolve in needed time for the patient. It would also force the patient’s husband to take attention
away from being with his wife at end-of-life and instead focus on the court case. This would
cause undo harm on the patient because she would not have the full attention of her loved ones as
she passed away.
Option Four: Honor the Power of Attorney:
22. ADVANCED CANCER PATIENT’S WISHES AT END OF LIFE 22
Finally, the hospital staff could simply honor the power of attorney and let the husband
continue to force his wife to do treatment. The hospital staff did try to help the husband see the
patient’s true wishes through multiple family care conferences. This option seems logical as the
hospital tried but, the power of attorney does have the final say in the care of the patient. While
this is true, the hospital staff and social worker are to advocate for the well-being and self-
determination of the client. To let the husband continue to make the patient undergo treatment
would be to not advocate for the well-being and self-determination of the patient.
Dilemma Resolution:
While these four options are viable solutions, the author would choose option one. Option
one presents the least harm to the patient and the husband while advocating for the patients well-
being and self-determination. If option one continues to produce no new results from the
husband and the patients time and well-being are running out, then option two may be a viable
option. This is not the first option to consider as it may harm the relationship between the
husband and the hospital staff. This would harm the psychosocial wellbeing of the husband
which would affect the patient. In addition, the husband may become upset with the hospital staff
and then continue to do what the thinks is best for the patient.
Option three is too drastic of an option for this case. The patient’s prognosis is not very
long and the goal is to give the patient the best quality of life possible. This option would cause
the husband undo harm and cause him to not focus all of his attention to the patient, which would
cause her harm. This option would affect both the husband and the patient’s psychological well-
being. This option does not advocate for the well-being of the patient. Therefore, this option was
not chosen. Finally, option four was not chosen as it did not fully advocate for the clients well-
being and self-determination. The hospital staff did try to help the husband realize his wife’s true
23. ADVANCED CANCER PATIENT’S WISHES AT END OF LIFE 23
wishes but, since he is the legal medical power of attorney, he can do what he thinks is best.
Although this is true, the hospital staff and social worker should continue to advocate for the
patient’s wishes, well-being, and self-determination. Therefore, this option was not chosen.
Option one, continued family care conferences, would allow the husband some time to
work through his grief and come to his own conclusion of what to do in regards to his wife’s
treatment. This solution would protect the psychological well-being of both the patient and the
husband. The husband is able to work through his grief with a supportive hospital staff and the
patient will be able to end treatment with her husband’s full attention. For these reasons, option
one would be the best option for action in this case.
Actual Case Resolution:
Since this case is from November 2015, the case was resolved. In the actual case, the
hospital staff and the Cancer Center Social Worker chose option one which is parallel with the
option the author chose. In the actual case, the Cancer Center Social Worker met with the patient
and her husband and found that the patient’s husband was upset that the patient had given up.
They had been planning their retirement together and did not get to enjoy it. After further
analysis it was clear that the patient’s husband had not processed his grief as fast as his wife did
and not as fast as her disease was progressing. According to Elisabeth Keebler-Ross, there are
five stages of grief normally experienced when facing a trauma. Everyone spends different
lengths of time in each stage and may not experience every stage. The stages of grief are denial
and isolation, anger, bargaining, depression, and acceptance (Axelrod, n.d.).
The patient and her husband moved through the stages of grief. At the beginning of her
diagnosis they were hopeful for a cure or a miracle even though the diagnosis was not very good.
24. ADVANCED CANCER PATIENT’S WISHES AT END OF LIFE 24
The patient moved through the stages into a stage of depression and being done to the stage of
acceptance when she spoke of wanting to end treatment.
The patient’s husband did not reach acceptance until much later. He often spoke of how
he was upset that his wife wanted to end treatment. He often spoke of hoping for a miracle and
thinking something could still save her life although she eventually moved into palliative
treatment that would only give her a couple of months or a year. The patient’s husband stayed in
the stage of denial for a long time regarding his wife’s diagnosis and prognosis. After further
family care meetings, the husband honored the patients desires and they went home with hospice.
The patient died on November 25th 2015.
25. ADVANCED CANCER PATIENT’S WISHES AT END OF LIFE 25
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http://psychcentral.com/lib/the-5-stages-of-loss-and-grief/
Briggs, B. (2015, March 9). Connecticut Teen Who Refused Chemo Now in 'Remission,' Seeks
Freedom. Retrieved April 4, 2016, from
http://www.nbcnews.com/health/cancer/connecticut-teen-who-refused-chemo-now-
remission-seeks-freedom-n320061
Cancer Center Social Worker [Personal interview]. (2016, April 6).
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Caring for People at the End-of-life. Retrieved April 4, 2016, from
file:///C:/Users/Asus/Downloads/Teachings of the Catholic Church - Caring for People at
the End-of-life (1).pdf
Clarke-Billings, L. (2015, December 1). Woman, 50 wins right to refuse life-saving treatment
because her 'sparkle' has gone. Retrieved April 4, 2016, from
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refuse-life-saving-treatment-because-her-sparkle-has-gone.html
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from http://www.irisproject.net/images/NASW_EOL_statement.pdf
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from https://www.socialworkers.org/pubs/code/code.asp
26. ADVANCED CANCER PATIENT’S WISHES AT END OF LIFE 26
National Center for Life and Liberty. (2015). How the "Right to Die" Came to America.
Retrieved April 4, 2016, from http://www.ncll.org/liberty-centers/center-for-life-
defense/cld-articles/57-how-the-right-to-die-came-to-America
Peppercorn, J., MD, MPH. (2013, February 15). A Common Theme Among Ethical Issues in
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Whitaker, S. (2015, October 23). Joey Rory Asking for Prayers After Stopping Cancer
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[The Hospital] Policy and Procedure. (n.d.). 2200.00 Mission Statement. Retrieved June, 2004,
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27. ADVANCED CANCER PATIENT’S WISHES AT END OF LIFE 27
Advanced cancer patient’s wishes at end-of-life:
An ethical dilemma
Social Work Senior Seminar
Gabrielle Lynn Cypher
4/25/2016