Question

Scenario:

You are a member of your hospital's ethics committee. A physician, Dr. Pierce, presents the following case to the committee, seeking a recommendation:

Jane Smith is currently hospitalized, for the seventh time in 11 months, and is suffering from the following conditions: hypertension, atrial fibrillation, and alcoholic fatty liver (exacerbated by continued heavy alcohol consumption). Jane is severely obese and unable to walk unassisted. Jane's medical condition is stable enough to be discharged, however, Dr. Pierce cannot in good conscience discharge her home, as she is unable to walk, and has no assistance at home. Jane is resistant to transfer to a skilled nursing facility, which is Dr. Pierce's professional recommendation. Jane is also receiving Medicare benefits.

• Briefly summarize the discussion points you would make during the committee meeting, including any questions for Dr. Pierce.
• One of your fellow committee members proposes that Adult Protective Services be called. What is the ethical implication of following this course of action, without informing Jane first?
• If Jane continues to refuse the skilled nursing transfer, and Adult Protective Services is not involved, could Dr. Pierce and/or the hospital be held liable if Jane passes away at her home due to her lack of mobility? Be sure to include in-text citations to support this response.
• In a concise paragraph, provide the committee's official recommendation, including rationale, for Jane's case. [Assume answers to your questions for Dr. Pierce]. This recommendation will be a legal and ethical protection for Dr. Pierce, and the hospital.

Answer 1

Answer:

The discussion points during the committee meeting:

A patient named Jane Smith is currently hospitalized, for the seventh time in 11 months, and is suffering from the following conditions: hypertension, atrial fibrillation, and alcoholic fatty liver (exacerbated by continued heavy alcohol consumption). Jane is severely obese and unable to walk unassisted. Jane's medical condition is stable enough to be discharged.

However there is no one to take care of him at home and since he cannot move by himself it is dangerous to discharge him. So I think a professional nursing assistant is needed for him at home.

The other committee members: This sounds a good suggestion.

Other: if the patient deny for the nursing assistant what can be done??

Other member: we can opt for adult protective services.

Dr pierce: we have some ethical implications for that.  In the United States, Adult Protective Services (APS) are social services provided to abused, neglected, or exploited older adults and adults with significant disabilities.

The major ethical implication is

• Recognize that the interests of the adult are the first concern of any intervention.

So if the patient refuses this will also be applicable for him.

Other members: " if the patient is discharged from hospital without any form of support due to deny of patient's consent will the hospital will take the responsibility of the death of the patient due to his immobility??

The official recommendations:

After the in depth discussion of the case they came to a conclusion that the patient can be discharged after getting legal consent from which states about the denial of the patient's consent for keeping a skilled nursing assistant and also for the adult protective services. This will ensure that the patient on his own conscience had agreed for discharge and is not willing for any kind of assistant for him. This way both the hospital and Dr.Pierce will be saved and have ethical protection.