Posted: February 5th, 2015

medical ethics of end-of-life-care

medical ethics of end-of-life-care

Order Description

Imagine that the nurse described in the scenario come to you for advice on how to handle the situation with Ms. Lykes in the most ethical way. Please provide an

ethical analysis of the pertinent issues and your recommendation.

scenario
Mrs. Almena Lykes is 24 years old and was diagnosed with amyotrophic lateral sclerosis (ALS) about 18 months ago. When she was admitted to the hospital with severe

pneumonia and shortness of breath, she had some movement in her arms and could not get around the wheelchair. Despite the physical, occupational and repertory therapy

and good nursing care, she became weaker since she being hospitalized. Test results indicates that her pneumonia probably develop because of weakness of the swallowing

muscle. She is discouraged knowing that her condition is going to get progressively worse and that she will eventually die. She is also believes that her husband is

not willing to care for her at home any longer, a fact her staff cannot confirm he has not called or appeared since she was admitted.
After a 2-week course, Almena‘s condition takes decisive turn for the worse. Dr. Jarda Roubal, her physician, believes that she is not going to be able to bounce back

from this pneumonia even with vigorous treatment with antibiotics and respiratory therapy because of rapid deterioration of her swallowing and breathing muscles. Dr.

Roubal discusses the seriousness of her prognosis and the options open to her intervention regarding to pneumonia and predicts she is near to the time when she will

has to make a decision whether or not she wishes to place on ventilator permanently. He answers all question directly about the seriousness of her prognosis. He ask

her nurse, Roy Moser, to place a respirator in her room for quick initiation of ventilator support should it be needed.
Yesterday evening, Mrs. Lykes and asked Roy to sit down with her by her bed, tearfully, she told him that she really was ready to die. She requested that that her

treatment in physical, occupational, and respiratory therapy be discontinued and that she not be placed on a respirator unless it would mean she would suffer less

while she was dying. She said she had seen a movie in which a woman was given morphine to speed up the dying process and make it painless and explained that was she

wanted. She is also requested a DOT NOT Resuscitate (DNR) status. “Dr. Roubal means well, but he will make a vegetable out of me,” she says, breaking down. Roy said he

would be sure to talk to Dr. Roubal about her wishes but that the final decision would be made by her and the team caring for her. Then Roy documented the conversation

in her clinical record.
That evening when Dr. Roubal came through to check on the patients, Roy Moser took him aside and conveyed the whole conversation as best he could recall it. Dr. Roubal

said, “What do think?” “I think we should do what she suggests. She isn’t going to get better.” After a moment, Dr. Roubal said, “well, you are right about her not

getting better, but I think she is depressed and once she still has a lot of life in her” Dr. Roubal then went to visit Almena. He said to her, “The nurse has told me

about your concerns. I would like you to think it over. There is still a lot we can do for you.”
Later that evening, Roy went back to Almena Lykes’s room. Almena looked extremely sad and alone, her eyes puffy from crying. Now she was dry eyed and made an attempt

to lift her limp hand. “I don’t know what to do” she said.

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