Final Paper Case Study Assignments 1-3

HCR 210: Ethics for the Healthcare Professional Case Study Assignments Case Study 1 Jim is a 30-year-old half Caucasian and half Hispanic male with a past medical history of schizophrenia, substance abuse, and homelessness. Jim was diagnosed with schizophrenia at the age of 17, and he suffers from paranoid delusions, visual and auditory hallucinations, and anosognosia (lack of insight into his own disease). When Jim was younger, he used to have a very supportive family including his father. His father guaranteed Jim a job with his landscaping company if he continued taking medications, to which Jim agreed. Unfortunately, Jim developed substance abuse issues and was fired his father due to numerous customer complaints of poor behavior. This led to a worsening relationship between Jim and his father. Jim is now homeless, although he does receive Medicaid benefits. For a while, Jim’s schizophrenia was well-controlled on the anti-psychotic drug aripiprazole, however he was switched to risperidone due to lack of Medicaid coverage. Jim never followed up with his psychiatrist after being switched, and he has run out of medications. Jim is now becoming increasingly paranoid and suffering from psychosis. He has been involuntarily committed to the hospital for the 7th time this year for a 72-hour watch. While Jim does not admit to any thoughts of harming himself or others, he is aggressively refusing all medications and wants to leave. When searching through the charts, the social worker found an advance directive from 6 years ago stating that he stating that his father is his medical power of attorney and that he would like to receive medications in the event of that he becomes “unable to care for himself.” When attempting to reach Jim’s father, the father states that he refuses to make decisions for his “useless addicted crazy son.” Jim is nearing the end of his 72-hour hold and will have to be discharged if no action is taken. What is the best course of action to take at this time? Case Study 2 Casey is a 6-month-old Caucasian female with a past medical history of tetralogy of Fallot, which is a congenital heart defect that causes difficulties with oxygenation. Casey’s pediatrician had diagnosed Casey with tetralogy of Fallot while she was still in the womb, and she was able to undergo a successful total surgical repair at 3 months of age. While recovering from surgery, Casey did require one blood transfusion. Casey’s parents are Jehovah’s witness and they initially did not consent to the transfusion. However, they eventually relented after feeling pressured by the surgeon and other hospital staff. While feeling somewhat uncomfortable with the blood transfusion, they are happy that their daughter is now doing well. At first, Casey appears to be cured and develops normally for the next few months. However, at 6 months of age, Casey is again showing signs of shortness of breath and difficulty breathing. After evaluation, the surgeon recommends another urgent corrective surgical procedure. It also is expected that Casey will lose blood during this procedure and require another blood transfusion. The surgeon mentions this to the parents, however the parents become offended. They feel like they have been lied to in the past when it was stated that Casey was now cured. The fact that they accepted a blood transfusion had caused them mental anguish and difficulty sleeping for the past few months. They are now refusing any type of blood transfusion, even if it would save Casey’s life. They argue that this would violate their religious beliefs, their right to privacy, and their right to raise their child as they see fit. However, the surgeon states that without the blood transfusion, Casey has a high rate of mortality during the surgical procedure. If the surgical procedure does not take place, Casey will most likely not live beyond 1 year of age. The surgeon argues that the parents do not have the right to make this decision for their child. What is the best course of action to take at this time? Case Study 3 Mrs. Lee is an 84-year-old Chinese female with past medical history of diabetes, hypertension, prior extensive cardiac history, major depressive disorder, and severe Parkinson’s dementia. Mrs. Lee’s husband passed away 3 years ago, but she does have one son and two daughters. She does not have an advance directive or an assigned medical power of attorney; thus, the surrogate decision maker becomes the majority of her adult children. Mrs. Lee was living in a memory facility, which provided 24-hour nursing care and attended to all of her needs. However, she sustained a ground level fall while in the memory care center and broke her hip. Mrs. Lee is now in this hospital, and this has caused her dementia to become even worse. She is routinely physically and verbally agitated. She requires soft wrist restraints, a bedside sitter, and frequent medication to calm help her down, but these measures are typically temporary and do not work well. Mrs. Lee is also evaluated by an orthopedic surgeon for her hip fracture. The surgeon states that a fracture of this type typically requires surgical correction. However, the surgeon refuses to proceed with any surgical intervention given her already poor health, high risk of mortality, and unlikely chance of meaningful physical or mental recovery. Upon visiting their mother, Mrs. Lee’s children become upset at seeing her current state. The son argues that Mrs. Lee has a right to undergo the surgical procedure. He feels a strong sense of filial piety and states that it would be unethical to allow their mother to pass away without trying to save her. He is hopeful that after having the procedure done, their mother will get better and go back to the memory facility. However, one of the daughters disagrees. She argues that their mother would not want to live like this and that they should consider palliative care measures. The remaining daughter is undecided and does not want to get involved. The hospital is unable to start any discharge planning until the children come to a majority consensus; however, this does not seem likely any time soon. Meanwhile, the hospital staff are having a difficult time getting Mrs. Lee to cooperate with their current treatment plans and this is adversely affecting staff morale. What is the best course of action to take at this time?