Reference no: EM134006557

Question

Reason for the Case: one sentence here describing the reason(s) for the case.

Summarize the relevant details of the case here. After reading this section, the reader should have a good sense of the facts and what ethical issues are apparent in the case.

Relevant Ethics Theories: [Define the relevant ethics principles and theories (at least 4) to which one might appeal or need in the analysis of the case. This section should include clear definitions of principles and theories based on course data. Definitions should be based on the bioethics book (vaugh), including clear references to the readings with proper citations. Lectures and other course tools may be used as secondary sources. (These also must be properly cited.)

Analysis: [Analyze the principles and theories (described above) in light of the case.

Recommendations: [Provide recommendations in the form of action items, points of consideration, and/or suggestions for addressing the ethical issues found in the case. These recommendations should follow logically and coherently from the analysis in the previous section (that is, the reader should easily recognize the rationale for these in the previous section). This section highlights the prescriptive process of ethics and, therefore, should contain several clear, concise "ought statements."]

The Case:

Joyce, a sixty-eight (68) year-old woman, is suffering from metastatic liver cancer, which has spread to her lungs and pancreas. She has been in and out of the hospital for several years and a few days ago moved back to California from Oregon. She has a POLST (Physician's Orders for Life-Sustaining Treatment) form from Oregon that indicates she does not want cardiopulmonary resuscitation and other treatments that will artificially prolong her life. She specifically requests no pain medication. Its date (with her and her physician's signature) coincides with her diagnosis of cancer. In Oregon, one oncology resident asked why she hadn't pursued Physician-Assisted Suicide as she fulfilled that state's statutory requirements for the program. She replied, "God is punishing me for my wrong-doings and abusing my body. I deserve it." At a hospital in California, the primary care physician has repeatedly asked Joyce if she would like more pain medication as she is constantly heard moaning and seen writhing in pain. Joyce always responds with the same simple answer, "Pain for purification and penance." Joyce's daughter has been visiting her on a regular basis and is confused by her mother's refusal of palliative care. She understands and accepts her mother's desire for her 'Do Not Resuscitate' (DNR) status, but is very troubled-to the point of tears-by her suffering. She is also troubled by why her mother feels so guilty. She thought her mother's refusal of pain medicine might have something to do with the guilt of a lost pregnancy, which may have caused the divorce between her and her ex-husband, but Joyce's daughter can't understand why her guilt is so profound. She notes that her mother had been an alcoholic since the divorce, when she was 43 years-old (25 years ago); this was also the time she believes she stopped attending religious services. The doctors and nurses are concerned that Joyce does not have decision-making capacity to refuse pain medication. Some caregivers claim that she is clinically depressed. A psychological evaluation revealed she is depressed, but Joyce refuses to take antidepressants. This also leads them to question the legitimacy of the advance health care planning information indicated by the POLST form. Joyce's actual advance directive is archived in her former place of residence-a long-term care facility-in Oregon and it has been difficult acquiring it. The care team is also concerned because Joyce's behavior (moaning and writhing) is disruptive to them and disturbing for the other patients in the unit. Nurse Green, the nurse manager, comes to you for help in determining how to handle the situation.