Reference no: EM133361170

Case Study #1

A 70 year old man is admitted to the hospital with a severe diabetic foot ulcer and associated cellulitis. Despite aggressive antibiotic treatment and wound care, the infection continues to spread, the tissue becomes necrotic, and the man becomes septic and medically unstable. He is moved to the ICU where he is informed by the physician that the only way to save his life is to amputate the leg, and even then survival would not be guaranteed. Even after a lengthy discussion with his health care providers, the man adamantly refuses surgery. His providers decide to perform the surgery anyway to save his life, feeling that the man just does not understand. The man survives and sues the hospital for performing the surgery without consent.

1. What ethical principle does this highlight?
2. Can you justify the provider's actions in this case?
3. What else could have been done to prevent this ethical dilemma?
4. When is it appropriate to supersede autonomy? If you had a court order, would that make this intervention ethical?
5. Would your feelings toward this case change if the patient was 21 years old? 90 years old?

Case Study #2

A 47 year old man with no other medical conditions is admitted through the with respiratory failure as a result of C OVID-19. He requires ICU level care and will need to be placed on a ventilator. Unfortunately, there are no more ventilators at the hospital; a discussion ensues that there is a patient from oncology who is currently on a ventilator who has terminal breast cancer and a life expectancy of less than 6 months.

1. What ethical principle does this case highlight?
2. What principles related to allocation of resources should be considered in this situation?
3. Who decides who lives and who dies? Would it change if the situation was reversed and the patient with COVID was on the ventilator and the patient with breast cancer needed the ventilator?
4. Would it change if the patient with breast cancer was 39 years old versus 89?

Case Study #3

A 9 month old patient comes to the clinical with their parents for a well visit. The topic of vaccines is brought up and the parents adamantly refuse stating that 'vaccines are just a money grab for big pharma." The primary care practice happens to care for multiple immunocompromised patients who cannot receive vaccinations due to medical contraindications.

1. Which ethical principle does this case highlight?
2. Discuss the harm/benefit balance to both the child and the community.
3. Should the patient be dismissed from the practice? Would this benefit the patient or the practice as a whole? Who has a greater right to beneficence?
4. Who decides what the benefit is for the patient?
5. Would your opinion change if the parents refused based on religious grounds?

Case Study #4

An 18 year old patient comes to the clinic as a result of a knee injury. She is a star basketball player and is planning to go to college on a scholarship next year. It is determined she has an ACL injury and that continued activity for her puts her at risk for further and perhaps permanent damage. She tells you that the championship game is next week and the school won't let her play without a note from the health care provider, and requests the note saying she will accept liability even if it is against medical advice.

1. Which ethical principle does this case highlight?
2. Should the patient be allowed to be cleared in this case?
3. Would there be harm to the patient if the note is written?
4. Would your opinion change if this was a minor and the parent was requesting a note? Or a professional athlete?

Case Study #5

Patient is a primarily bedbound woman in her 80's with a diagnosis of aggressive form of leukemia, was previously on chemotherapy, and has become transfusion dependent relative to the AML. She can transfer to a commode, but is unable to work with PT/OT due to low platelet count, is at increased risk of transfusion reactions. The oncologist has explained that side effects of future chemo would be worse than previous treatments. The patient does not want further chemo but wants to appease her family. Her prognosis is guarded. The family (3 adult children; she is widowed) is dismissing hospice care, and wants their mother to pursue chemo/radiation treatment without hesitation.

1. What conflicts are there between or among values, beliefs, goods or benefits?
2. What are the ethical principles involved in this case?
3. Who does the nurse support in this case?