Question

1. Mrs. Elle, 80 years of age, is a female patient who is diagnosed with end-stage cancer of the small intestine. She is currently receiving comfort measures only in hospice. She has gangrene of her right foot and has a history of diabetes controlled with oral agents. She is confused and the physician has determined that she is unable to make her own informed decisions. The hospice nurse, not realizing that the weekly order for CBC and renal profile had been discontinued, obtained the labs and sent them to the nearby laboratory for processing. The abnormal lab results obtained later that day revealed that the patient needed a blood transfusion. The hospice nurse updated the patient’s medical power of attorney who was distressed at the report. The patient’s wishes were to die peacefully and to not have to undergo an amputation of her right foot. But if the patient receives the blood transfusion, she may live long enough to need the amputation. The patient’s physician had previously informed the medical power of attorney that the patient would most likely not be able to survive the amputation. The patient’s medical power of attorney had made the request to cease all labs so that the patient would receive comfort measures until she died. The patient has no complaint of shortness of breath or discomfort. (Learning Objective 4)

What ethical dilemma exists?

Who are the stakeholders and what gains or losses do each have?

What strategies should the hospice nurse take to resolve the ethical dilemma?

Answer 1

1.In ethical dilemma ,each alternative course of action can be justified by two way in which a person views the course of action based on his or her value system.The ethical dilemma which exists in this situation is about the need to make treatment and care decisions for terminally ill patients who already has given a DNR consent.

2.The primary stakeholder will be the patient herself.if she recieves treatment she may survive ,eventhough it requires amputation as she has no other discomforts.But the patient has to continue her remaining life with an amputed leg and the chances are also negligible.

The health care proxy or the medical power of attorney will be the second stakeholder, as on hearing the unexpected lab reports which indicate chances for surviving the patient .This makes him feel confused about the decision he had made and cause unnecessary guilty feeling .As the patients chances of surviving the amputation is negligible.

• Identify the problem.
• Gather data to analyse the causes and consequences of the problem.
• Explore the optional solutions to the problem.
• Evaluate these optional solution.
• Select the appropriate solution from all the options.
• Implement the selected solution.
• Evaluate the results.