November , 2012
This paper provides a case study and the beginning steps of a successful analysis and resolution for a case study. Listed will be the identification of ethical problems, listing of priority data, the identification of missing data, the identification of all ethical options and the support for each ethical option and lists conflicts with moral self within the body.
ES is an 82 year old female who is currently a patient in a mixed rehabilitation/skilled nursing care facility. She was admitted three weeks ago after a broken hip pinning. She plans to be discharged back to her home which she shares with her son and daughter in ...view middle of the document...
ES is scheduled this afternoon to transfer back to the hospital for a routine x-ray of her hip, to check progress of the healing and confirm pin placement. This morning she must receive a unit of PRBCs over four hours. You have a valid MD order and the unit has arrived from the Red Cross distributor. Unfortunately you see that there is no consent in the chart. You call the MD but she does not return your call. You call the son, but he does not call back. The blood will cost $185 to your facility if you do not administer it within 6 hours even though it is being stored in an approved Red Cross refrigerator. The x-ray scheduled will require that ES be sedated for her anxiety related to the ambulance ride between the facilities. She really gets upset and feels like the drivers will have an accident with her in the back. You notice that your medication dispenser does not have valium stocked in 4mg tabs, she usually takes 2 tabs. The pharmacy restock will not occur until tomorrow. The LPN who usually takes care of her thinks this is too much Valium just for the ride and tells you to consider other options using 2mg tabs. The physician’s assistant on duty suggests giving ES a total of 4mg…2 tabs of the 2mg. In fact, he tells you that ES was really too tired to participate in physical therapy (PT) the last time she got 8mg. ES only has 5 more days of PT left on her insurance, so everyday counts. When the ambulance company clerk calls to confirm the transport for ES, she inquires about ES and her health status commenting about the son and his odd decision about the bleeding problem. The clerk asks how many transfusions ES has had this month and how many more times she will need to be transported for x-rays.
I. Identify Ethical Problems
a. DNR required for admission to Rehabilitation facility. This is an outright violation of her autonomy and a risk to her beneficence and a potential risk for injustice. The Patient Self-Determination Act, (PSDA) became law in 1991. It mandated that all hospitals accepting Medicare funding offer written information concerning patients’ rights to make decisions concerning their health care and their right to consent to or refuse medical treatment (Smith, 2000). This act did stimulate increased interest as evidenced in the upsurge in medical and nursing literature concerning a patient’s right to self-determination with special attention to advance directives and DNR status (Margolis et al., 1995). (Grace, 2009). DNR is a medical order to be given only by authorized health care practitioners. DNR orders generally should be given with the informed consent of the patient or the patient’s surrogate decision-maker. Ideally, the physician should sensitively discuss the DNR option with the patient while the patient is mentally competent. However, DNR orders are often considered for patients who are comatose or who otherwise lack decisional capacity with whom this discussion has not occurred...