Case Study of Ann – Legal and Ethical Issues in Nursing

Ann’s Case Study

Ann is a seventy-seven-year-old grandmother. She has one daughter and three grandchildren. Two years ago, she was diagnosed with moderately advanced Alzheimer’s disease, which causes her to have periods of confusion, frustration, anger, and obsessive thinking. When speaking, she is uncertain and her speech patterns are choppy. Before her mental deterioration, Ann was a woman of love, intelligence, and patience. Realizing they were getting older, she and her husband, Frank, discussed their wishes should anything happen to them. She told Frank that if there was no chance of survival, she would not want to be hooked to a breathing machine. They never got around to filling any papers.

Frank is a sweet and sensitive man. His wife’s state frightens him. Ann’s love for him has been the focus of his life for sixty years. His urgent desire for the best care for Ann shows his devotion and love. Their daughter, Sarah, is a businesswoman. She is a hard worker and a good mother. She is forty-five, successful, and intelligent. Although she loves her parents dearly, she lives ten hours away. She regrets not seeing much of them, especially recently. Frank feels his role is to take care of Ann. He has spent the past year with her, watching after her, cooking for her, cleaning the home, and witnessing her deterioration. Finally, Ann is unable to walk alone safely and he finds he must have her admitted to a long-term care facility. He calls Sarah to come and help with the arrangements. After having Ann admitted to a local nursing home, both Frank and Sarah remember the pleading look in Ann’s eyes as they walk away.

After three weeks in the nursing home, Ann starts to cough and run a fever. She is seen by doctors and diagnosed as having pneumonia. She is transferred to a local hospital, where she is given intravenous antibiotics. Although the progress of her pneumonia is halted by the antibiotics, she stops talking and refuses to eat. The physician calls Frank to insert a feeding tube. Frank calls Sarah to ask what to do. They wonder, Is a feeding tube equivalent to a breathing machine? Would it be possible to allow Ann to lie there and die of starvation? Is that murder? What would she want? What is the right thing to do? (Burkhardt & Nathaniel, 2008).

Respond to the following:

  • Discuss the ethical decisions you would make.

Nurses have an ethical obligation of improving the patient’s quality of life. In this regard, nurses have an ethical obligation to offer compassionate and comprehensive care including pain relief, promotion of comfort, and support for families, patients as well as their surrogates in making important decision regarding the form of care to be given to the patient. Based on this case, a nurse is ethically compelled into providing the best care for the patient as he or she considers best to save the life of the patient since pneumonia is a curable condition. This should take place until the family members provide a decision on the kind of procedure they would wish for their loved one (ANA Position Statement, 2003).

  • Discuss the legal decisions you would make.

Legally, a nurse is bounded to obey the advanced directives condition set by the patient when in sound mind. If this is not clear on the directive, the individual chosen by the patient to deputize in making medical decision should provide a nurse with the way forward. While that directive is not there, the nurse is compelled to adhere to the family decision regarding the kind of care that they would consider best for the patient. Legally, the nurse is protected by the law from any unethical procedure demanded by the patient through a directive or that provided by the patient deputy or that provided by the family members in absence of a directive. However, in absence of a directive, a nurse is required to advise the family members to make an informed decision. Therefore, I would advise the family and wait for their decision regarding the next move after doing what I consider necessary to assist the patient (Family Caregiver Alliance, 2015).

  • Explain, as a nurse, what advice would you give to Frank and Sarah.

As a nurse I would clearly explain the situation to Frank and Sarah, and provide them with the chances that Ann would be better if the feeding procedure takes place. If the chances of survival are slim I would encourage them to adhere to Ann’s demands. However, if Ann will get better I would encourage them to give her another chance to live despite being against her wish. It would be important for them also to know that the law provided them with the greatest power to decide on Ann’s ate based on the fact that there is no any directive signed by Ann. I would also explain the feeding procedure to ensure that it does or does not go against Ann’s wishes. I would also explain to them what it means to deny Ann the feeding procedure and how it will affect Ann and her health (Flower, 2010).

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