Case 1
Sean, a gentleman in his early 80s, had had palliative radiotherapy for cancer of the lung and had a chest infection on admission to hospital. I met up with the family about three days after I admitted him when I took a report from a colleague at 5 pm in the evening, to hear that the patient’s condition had deteriorated. His oxygen saturations had dropped. He was on the medical unit and had been transferred to the high care unit and he was dis-improving. I asked what the plan of care was for him and I was told that the family wanted him to have every possible chance.
The consultant was not on duty that day. There was someone acting for him until 5 pm in the evening and as far as they were aware, the gentleman was to be resuscitated. I asked had the fact that he had a chest infection as well as CA of the lung, (he knew what was wrong with him), been discussed with the patient and I was told no, because the family wanted him to have every chance. Before I got to the end of that report the emergency bleep went off and it was for this patient. When I got to the unit the patient was intubated. I asked the nurses about it. They said yes the family wanted it - the doctor had discussed it with the family and they did want resuscitation measures taken if anything happened. They knew that their father was getting worse. The father himself had expressed that he didn’t want tubes or anything like that, so I was very annoyed really. I couldn’t understand how it had gotten to this stage.
1. Identify and discuss at least one of the ethical issues that arise in this case with reference to appropriate ethical principles and values or any relevant duties imposed by professional and legal standards. (50 marks)
Case 2
I was working on a mixed ward for more able intellectually disabled residents. Mary was 54 years of age and approximately two stone overweight according to her height-weight ratio. She enjoyed her food and had no medical problems. However, the ward sister decided that she should be placed on a reducing diet. Mary was generally well behaved and was capable of going into town on her own, dressing herself and maintaining her own hygiene. However, after a few days of being on her diet, she was caught stealing food from other residents and on more than one occasion, taking food from the rubbish bins.
On one particular Friday, it was fish on the menu. All of the other residents had fried fish and chips, but Mary was given boiled cod. She expressed her dislike of the food and said she did not want to eat it. One of the qualified staff forced her back into her seat and repeatedly shouted at her saying, ‘You will eat this food’. When Mary still refused, the nurse attempted to force feed her.
Mary became very distressed over the incident and gradually appeared withdrawn and depressed. I spoke to the ward sister, saying that I felt it was unkind, that Mary should have some choice in the matter of her diet especially as she was a voluntary resident, and that force feeding isn’t even allowed in prison.
The sister brushed aside my complaints saying, ‘It will be good for Mary to lose weight and anyway we can’t let her get the better of us, can we?’. The sister’s attitude was made much worse by the fact that she herself was at least three stones overweight.
2. Identify and discuss at least one of the ethical issues that arise in this case with reference to appropriate ethical principles and values or any relevant duties imposed by professional and legal standards. (50 marks)
Case 3
A young mother, whom the High Court ordered should be given a blood transfusion against her will in a bid to save her life, was recovering at a Dublin maternity hospital last night. The 23-year-old Congolese woman suffered massive blood loss following the birth of her first child at the Coombe Women’s Hospital early yesterday. However, speaking in French and through an interpreter, she told hospital staff she did not want a blood transfusion as she was a Jehovah’s Witness.
The hospital’s master, Dr Chris Fitzpatrick, rushed to the High Court for direction and, at an emergency lunchtime sitting, Mr Justice Henry Abbott was told the woman, known only as Ms K, had lost 75-80 per cent of her blood and was likely to die within hours unless a transfusion was authorised by the court. The judge directed the hospital to do everything in its power to save the life of the woman and said staff could restrain her if she physically attempted to stop doctors administering to her a life-saving transfusion. He said the interest of her newborn child, a boy, who he was told was ‘in good shape’, was paramount and the baby could be left with no one in the State, as far as was known, to look after its welfare, if its mother passed away. (Eithne Donnellan, The Irish Times, 22 September 2006)
3. Identify and discuss at least one of the ethical issues that arise in this case with reference to appropriate ethical principles and values or any relevant duties imposed by professional and legal standards. (50 marks)