thical Case Study

Walking The Tightrope

From http://www.practicalbioethics.org/case-studies-walking-the-tightrope

***Use the discussion questions below for this course  discussion

Undermanaged Pain Makes for an Unattractive Patient

An eighty-five-year-old widow has been in a long-term care facility for six months. She was admitted with severe osteoarthritic and osteoporotic pain. Her family initiated her placement because she was overmedicating herself at home, confusing her medications, and not eating adequately. She has been a complainer for years, the family reports. The family and physician are reluctant to give her strong pain medicines; they dont want her to be doped up like she was at home. She currently takes two Tylenol every four hours, which does not adequately control her pain (and risks liver and kidney toxicity). She is in too much pain to walk, but quickly becomes uncomfortable in the wheelchair. So she requests bed rest and frequent repositioning. Staff feels she is demanding and hard to please. She has a son who calls and tries to visit once a week, but who becomes tired of hearing her constant complaints of pain. Her daughter lives out of town, and calls weekly.

The son asks the doctor to make her more comfortable and assuage her complaints. But the son also requests that the doctor not give her whatever she received six months ago (at the time of admission) when she drooled and was unable to sit up or eat.

Her sister has called the state regulatory agency to complain that the facility staff is neglecting her and not taking care of her pain.

The doctor agrees to try Nalfon, a nonsteroidal anti-inflammatory drug (NSAID). After two weeks, she has dark, tarry stools, suddenly vomits blood, and is hospitalized for a severe gastric bleed.

Use this resource for discussion response as needed:

ANA Code of Ethics at http://www.nursingworld.org/codeofethics

Questions for discussion

Is the patients autonomy being respected by involving her in the decision-making process?

How could a meeting of all parties involved have been more effective and/or ethical than piecemeal decision making?

What ethical principles do you see of concern with this case study?

Does the nurse have a moral responsibility to be more assertive in advocating for the patients relief?

Given that the doctor is likely to see the resident only every two months, what role should the doctor take in assessing and monitoring the pain and its treatment?

Explain the ANA Code of Ethics provision(s) you think is violated in the case study and why was it violated?  Describe how you could apply the ANA Code of Ethics in the case to uphold the provisions.

List one assumption pertinent to this case that you would like to check and why.

What other issues do you think this case explores?
. Ask one question to the class
Please make show APA and references is quoted correctly.