Part 1: The Ethical Case Study Paper
Read the textbook chapters, specifically Chapter 20, and review the PowerPoint presentation to prepare for this assignment.
This assignment is directed at reviewing an ethical dilemma for an elderly patient. Please answer the questions for the case study 20-1 in your Mauk textbook regarding Mr. Bowen. Answer all seven of the posted questions thoroughly.
CASE STUDY 20-1:
Mr. Bowen is 74 years old. He has been very healthy by report and very active working as a farmer. He had a right-sided cerebral vascular accident (CVA) 14 days ago and currently has a moderate leg weakness with a more significant arm weakness, slurred speech, and mild dysphagia (swallowing difficulty). He is predicted to be ambulatory with a cane, though prognosis of arm function returning is more guarded. It is likely he will improve speech function and swallowing ability but will require some specialization of diet to prevent aspiration.
Mr. Bowen has chosen to stop eating, stating that he does not want to live as an invalid. His family is very distressed and wants the nursing staff to force him to eat. The staff cannot imagine why he has made this choice, given that his prognosis is so good compared to others they have seen in the rehabilitation setting with much more severe deficits. He has been evaluated for depression and an antidepressant has been ordered, which he refuses to take, along with all other medications for his newly diagnosed cardiovascular disease. Mr. Bowen is oriented to time, place, and person. He has never had his competence questioned prior to taking this stand on self-determination. Mr. Bowen has decided to stop eating because he does not want to live as an invalid. His family is distraught, and they want the nursing staff to force him to eat. The staff are baffled as to why he has taken this decision, given that his prognosis is so favorable in comparison to others they have seen in the rehabilitation setting with far more serious deficiencies. He was assessed for depression and given an antidepressant, which he refuses to take, along with all other prescriptions for his newly discovered cardiovascular condition. Mr. Bowen is concerned with time, location, and people. Prior to embracing this stance on self-determination, he had never had his competence called into doubt.
Some of the staff supports his decision and others do not. Discussion with the family reveals that Mr. Bowen has frequently made deriding remarks about persons with disability, including remarks like “If I ever end up that way, just take me out behind the barn and shoot me.” The psychologist comments that Mr. Bowen is clinically depressed and that part of this depression is related to the location of his stroke, which prevents him from going back to working on the farm. He also points out that, in his strong opinion, should the depression be resolved, Mr. Bowen would most likely change his opinion.
1. What is the healthcare dilemma? identified in this case study?
2. What principles of healthcare ethics can be identified in this case study?
3. Does Mr. Bowen have the right to refuse to eat and take medications when he is clearly not in an end-of-life situation?
4. How does the team resolve the situation when the depression is so prevalent and he refuses treatment for it?
5. As the nurse, how will you approach and direct the care for Mr. Bowen?
6. What elements (provisions) from the code of ethics come to mind as you prepare to care for Mr. Bowen?
7. Can you apply theory related to the concept of grief to the care of Mr. Bowen?
Create a Power Point presentation to submit the answers to the case study.