Question

 End-of-Life Care and Decision Making

 Kelsey is a nursing student in her first clinical rotation. One of her classes focuses on bedside manner. The purpose of the course is to give students time to speak with patients and understand their perspectives - their knowledge, hopes, and fears. Kelsey and a few of her classmates are assigned to a hospice, where each spends time talking in a non-medical capacity with a patient. In the previous semester, the students heard lectures on how to take histories from different types of patients (e.g., children, the elderly) and on special topics (e.g., cultural

 sensitivity and end-of-life care). Kelsey had had one lecture about talking with the elderly and one lecture about end-of-life issues and options before her first visit to the hospice.

 On one trip, Kelsey was assigned to spend time with Mrs. Walsh, an amiable 70- year-old woman who had entered hospice care 2 days earlier. Mrs. Walsh's chart said that she and her family members had elected to discontinue chemotherapy, which was making her feel terrible and not having any effect on her cancer, which

 had metastasized to her spine and lungs. Mrs. Walsh had a do-not-resuscitate

 (DNR) order in place. The visit was going well: Mrs. Walsh was talking happily about her husband, her children, and her grandchildren. Then Mrs. Walsh related her struggles with cancer and the decision to enter hospice care. Next Mrs. Walsh began to talk about facing mortality and said she was frightened about how she would die. She was not sure what the end would be like for her and questioned whether hospice was the right choice, though she was not really sure what would

 have been a better choice.

 Throughout this time, Kelsey remained quiet. She wanted to empathize with Mrs. Walsh, to encourage her to continue thinking about these tough topics, and to ask questions that would help Mrs. Walsh flesh out her own ideas. She wanted to talk

 about the other options (not having a DNR order, receiving aggressive treatment,

 dying in an ICU on a ventilator) in ways that might remind Mrs. Walsh why she and her family had chosen hospice care in the first place. But Kelsey didn't know whether she was allowed to enter into this type of conversation with a patient- she'd barely begun her nursing training, after all.

 Adapted from: Tan, A. (2013) Medical students and dying patients. AMA Journal!

 of Ethics, 15(12), 1027-1033,

 Questions

 1 What ethical theories and principles are involved in this situation?

 2. How might Dr. Timothy Quill analyze Mis Walsh's case?

 3. If you were Kelsey's clmical instructor, what advise might you share with Kelsey about Mrs. Walsh and being in a similar situation in the future?

Answer 1

1. The ethical principles involved here are Beneficence and Non- maleficence . Means doing good for the patient and not to harm the patient . Here in this case Mrs. Walsh and her family members has refused for the further chemotherapy as it was not giving any relief other than pain and side effects .

Autonomy is also used in this case . Do not resuscitate is the patients decision making that she does want to be put on ventilator as it would be painful and she wants a natural health .

2. It's just simple to analyse her case as she and her family does not want to continue chemotherapy and has signed the DNR in terms of her autonomy and it was a easy decision for Dr Trimothy to make the regarding her health care .

3. Kelsey was new to this ,she should use a open two way communication aproach and ask the patient to express her feelings and concerns , which will help the patient to express her emotions and decrease her anxiety level about mortality .