Reference no: EM133897768

Mr. Howard is a 63-year-old man referred to the home health nurse for evaluation and treatment of stasis ulcers on his legs. When Karla Long, the home health nurse, visited the home, she found large, oozing, sticky areas of raw tissue on Mr. Howard's legs. Ms. Long cleaned and dressed the ulcers and continued visiting the Howards several times per week.

As the ulcers began to heal, Ms. Long engaged the Howards in discussions about nutrition and hydration and encouraged them to start a weight reduction program (both of the Howards were grossly obese). Mr. and Mrs. Howard were not interested in weight reduction, and Ms. Long's visits were over.

Several months went by and Mr. Howard's ulcers began to deteriorate. He was hospitalized, treated, and returned home. When his condition deteriorated a second time,

Mr. Howard was again hospitalized but, after a few days, he signed himself out of the hospital. Angered by Mr. Howard's decision, his physician refused to continue treating him.

Ms. Long was then left without continuing physician orders to visit the home. She explained the situation to the Howards and taught Mrs. Howard to wash her husband's legs and to apply the medicine to them. Mr. Howard seemed satisfied with this. He claimed that the physicians had not really improved the condition of his legs and that he had no intention of seeking any medical help for his condition in the future. Ms. Long left her telephone number with the Howards in case they ran into any further problems.

Nearly a year passed. One summer day, Mrs. Howard called and said her husband was "awfully sick" and could not even get out of bed. The policy of the home health agency allowed Ms. Long to make a one-time-only evaluation visit, so she did. She found Mr. Howard's legs alive with the larvae of the summer flies attracted to the non-air-conditioned bedroom. She urged that Mr. Howard be hospitalized. He agreed and was transported to the local hospital by ambulance. Because of the extreme condition of his legs, a bilateral leg amputation was performed. When news of Mr. Howard's general condition got out (he had created quite a sensation in the emergency room of the local hospital), the citizens of his small town were aghast. How could a man be allowed to rot away? Where were all the home health services for the poor? Who was responsible? An investigation was done, but months later,"no-fault" was found, and it was announced that the community health services had sufficient mechanisms to prevent such a thing from happening again. But Ms. Long was not satisfied.

Questions:

1. Do you think Mr Howard had a right to refuse treatment for his condition?

2. If you were Ms. Long, would you have done anything differently and why?