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Competency and Self-Determination in elderly patients

Mrs. Jane Doe is a 80-year old, retired, widowed school teacher who has been living in an apartment at the FED Assisted Living Facility for 4 years. She was recently diagnosed with chronic renal failure. Her doctor is recommending dialysis. She has no family remaining but does have comfortable resources as she has lived frugally most of her life. She refuses to go along with this recommendation because her older sister has died while on dialysis with horrible side effects.
Helen's doctor insists that dialysis would improve the remainder of her life with no side effects. Although she does not want dialysis, she is aware that some of the staff are concerned that she may no longer be able to make good decisions and are trying to conceive her to agree to the dialysis.

What is your analysis of the various ethical considerations involved in this situation? How should the competing ethical considerations be resolved? Argue both sides of the issue, basing arguments on ethical theories and/or principles.

Solution Preview

This case presents an 80 year old retired school teacher with chronic renal failure with three interesting issues.

First, she refuses dialysis because her older sister has died while on dialysis with horrible side effects.
Her refusal to treatment is based on a preconceived notion derived from observation. It is important to understand that this notion is accompanied by fear which can affect the ability of the patient to choose (Marsh, 1986). On the patient's favor is the fact that as a school teacher she has the ability to analyze objectively the situation if she is given the facts without imposing views and her concerns are addressed in an objective way. In any situation where the patient refuses treatment, it is important to ensure that the patient understands her condition and the treatment alternatives.

Second, her doctor insists that dialysis would improve the remainder of her life with no side effects.
Treatment is based on a cooperation agreement between the patient and the doctor (Marsh, 1986). This cooperation can only happen when there is an established communication process where the health care professional (HCP) is able to objectively explain in a language that will make sure the patient comprehends
?"The nature and purpose of a proposed treatment or procedure;
?The risks and benefits of a proposed treatment ...

Solution Summary

The solution involves the discussion of a case involving an 80 year old patient with chronic renal failure who refuses treatment from three diferent perspective- the patient, the doctor and the nurses. Concepts like the decision-making process, informed consent, doctor-patient relation, and nurses' ethical and legal obligations toward the patient are included in the discussion.

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