Scenario: A 96-year-old male patient is admitted to the ICU with terminal liver

Question

Scenario: A 96-year-old male patient is admitted to the ICU with terminal liver cancer. He is confused and disoriented, very skinny and appears underfed, and is covered with bruises, which are common in patients with liver disorders. His daughter, who is a naturopathic physician, insists that she can cure her father by administering unknown substances, some of which smell like feces and look like tar, down his NG tube. He is clearly in pain after she does this. She insists that these are life-saving interventions on her part, but the nursing and physician staff caring for the patient are very upset and concerned that she is hastening his death. They have come to you for help. Address the following to generate your conclusions about how you would proceed:

a) What are the dimensions of the ethical dilemma?

b) What are the issues?

c) Apply the four core ethical principles and the process of ethical decision making.

Explanation / Answer

A. ANS: Ethical dilemma:

It is an option which was chosen by a person among the two options. Ethics and morals are inseparable. They both deal with questions of right and wrong.

B. ANS: Issues:

The first is the patient that is 96 years old and he has liver cancer. There is no mention of any others diseases or complications; however, given the patient’s age, there are probably other health issues. According to the National Cancer Institute, typical symptoms of liver cancer are, pain in the upper abdomen on the right side, a Ethics in Healthcare lump or a feeling of heaviness in the upper abdomen, a swollen abdomen, loss of appetite and feelings of fullness, weight loss, weakness or feeling very tired, nausea and vomiting, yellow skin and eyes, and fever. From the description in the scenario, it is not clear who brought the patient into the hospital.

The patient daughter is a naturopathic physician. The daughter is insisting that she can cure her father by some smelly tarry substance. The chemical poisoning symptoms are so closely related to that of the symptoms of liver cancer, some of the daughter’s treatments could be masking the liver cancer symptoms causing problems of correct diagnosis and treatment.

C. ANS:

The four aspects of ethical decisions are welfare, interests, moral status, and social mores; whereas, the four ethical principles are, autonomy, beneficence, non malfeasance, and justice. It is possible to apply the four aspects of ethical decisions along with the four ethical principles (Pozgar, 2007).

Autonomy refers to the patient’s right to make their own decisions and informed choices about the care they want or are to receive. In this case, autonomy could be compromised because the patient has been described as being incoherent. The patient may not be able to make proper decision. Regarding principle of beneficence requires that all actions taken on behalf of the patient be done so to provide the best possible outcome. The daughter obviously feels that it in the best welfare of her father to receive the treatment that she has prescribed. The doctors feel their treatment is the best. From description in the scenario, it is not clear how long the patient has been treated by doctors or by his daughter. It is clear however that the daughter’s treatment is causing her father’s condition to worsen. Clearly, from the scenario, both healing parties are inflicting harm on the patient.

In the case presented in the scenario, the justice aspect does not seem to apply. The patient is obviously in need of intensive care and from a triage point of view probably is just as deserving as anyone else. The father deserves the right to be treated in a manner that does not cause further harm to him. In addition, his symptoms might stabilize such that he would become coherent and be able to decide for himself the treatment that would be best for his health. If, for some reason, the father does not regain his mental facilities, then someone other than his daughter should make decisions.

References:

Association of Accredited Naturopathic Medical Colleges. (2010). About the AANMC. Retrieved from http://www.aanmc.org/aboutaanmc.php.

Pozgar, G. C. (2007). Legal aspects of health care administration, 10th ed. Sudbury, MA USA: Jones and Bartlett Publishers, Inc.

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