(6th 3d = Case 14)
Sarah: outline the case, distinguishing ethical from medical/social/legal/other issues, and any other information necessary to understanding the case (you might want to do a tiny bit of research if there's some particular angle that seems interesting to you). You are also responsible for constructing relevant (thought-provoking) questions to start discussion on the case issues.
Others: respond to Sarah's awesome questions/discussion prompts.
Bill has recently been paralyzed by a stroke, he is now about to be discharged from the hospital with the choice of going home or to a nursing home. Bill’s wife, Amy, has a heart condition and is unable to provide, by herself, all the necessary care Bill will need at home. Dr. Z feels that bill should go to a nursing home. Bill is adamant that he wants to return home. At this point, all Dr. Z should do is explain why he believes a nursing home is the best option but then start preparing for Bill to return home, respecting his autonomy. They should discuss the set up of their home, (i.e., the need for mechanical lifts, an electric wheelchair) and give the option of a home health nurse for assistance. Amy feels that Bill will refuse a nurse, but that can change after he gets home and sees how difficult it will be by themselves. Ideally, Bill will get home, get rid of the stress of being in a hospital and realize what burden he is actually asking his wife to bear. If he remains adamant that the only one to take care of him will be Amy, then Amy will have to take care of herself and hire a nurse or some form of help without her husband’s consent. For as long as a patient is mentally capable of making decisions and communicating those decisions they are in control of their care and always have the right to refuse the doctor’s recommendation regardless of what any friend of family member may want. A physician should provide the patient with information and a clear understanding of all options, provide their recommendation, and then respect the patient’s choice and give them the best outcome possible from that choice.
ReplyDeleteAs a physcian, the job of the doctor is to inform the patient of his options and the risks and benefits of each. It can be natural for the doctor to want to give his/her opinion, especially when he has more knowledge about the situation, but in the end, the patient has the ultimate right to choose how he lives his life. As far as the family is concerned, they are not the responsability of the doctor; his obligation is to his patient. He shold give the patient information about how his decision will affect his family, but he(docotr) should not pressure or threat the pateint into making a decision just because it is morally right. Unless the patient has a legal mandate, the doctor should not force a patient to do anything. (A legal mandate such as the patient is returning to jail after his treatment.)
ReplyDeleteI do not feel that Dr.Z should threaten Bill. A physician should never use threats to persuade his patient to do what he feels is right. What is right for one patient may be totally different for the next. Dr. Z should handle this situation by telling Bill the risks and benenifts of each of his options. In this case, I feel the family members interest should be taken into cosideration. Both the doctor and Amy know she will not be able to care for Bill. Since Dr. Z is aware of this, he should not give Bill the option of returning home without care. A physician is suppossed to watch out for the patients best interest. It would be wrong for the doctor to discharge Bill knowing he is not going to be able to get all the proper care he needs at home. I do not feel the doctor should pressure the patient into doing something. However, the doctor should be honest inform the patient of every possible consequence of his decisions.
ReplyDeleteI agree with Laura and Tara. The doctor should not threaten to remove himself from the case to persuade his patient into doing something he doesn't want. The doctor has the responsibility to inform his patients of their rights but shouldn't back out of his duties to treat a patient because of their wife's requests. Bill is an adult and is capable of making his own decisions. Unless Amy gets power of attorney over him she cannot make him go to a nursing home. Hopefully she will be able to convince him that she is not capable of taking care of him properly and since he refuses even home care it will impair his wife even more because she will have to give him total care since he is paralyzed.
ReplyDeleteFirst Dr.Z. should see if Home health care is available around the clock and if their insurance could afford it.The family members most definitely have baring on the patients well being, if the wife is not capable of taking care of the patient under not circumstances should the burden be placed upon a frail women, home health care is essential if the patient is insistent on being at home. This is one way of not abandoning the patient, and keeping the couple together. The physician has no right to pressure anyone to do anything , but it is in his best interest to explain the risk and serious responsibility of those who will care for the patient. It is also his obligation to seek as much help from a social worker to work with the couple.
ReplyDeleteBill S, an elderly patient, has been paralyzed by a stroke but retains decision-making capacity. The patient’s physician, Dr. Z, believes Bill should enter a nursing home following his discharge from the hospital. However, Bill insists on returning home, despite his only caretaker being his frail, elderly wife, Amy S, who is incapable of physically caring for him. She tells her husband that if her health fails he may end up in a nursing home anyway. Amy S pleads with Dr. Z to intercede when her husband remains adamant. Dr. Z thinks that by threatening to withdraw from the case he might be able to get Bill S to change his mind. Bill S having the right to decide to go home is an ethical issue, Amy S not being able to care for her husband is a medical issue, and Dr. Z threatening to withdraw from the case because Bill is attached to the physician is both a social and a medical issue.
ReplyDeleteWhat would you do if you were Dr. Z?
Is Amy wrong for wanting her husband to go to a nursing home despite his wishes to come home?
Do you think it is okay for Dr. Z to threaten leaving the case to get Bill to change his mind?
Under what circumstances (if any) should a physician get involved in a conflict between his patient and his patient’s family members?
Friendly and quick. For a person who hated going to the dentist I am not dreading my next cleaning!
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