Final Case Study

Use Deventer’s model (listed on the “Guiding Thought” page) and refer to the case analysis questions for discernment to analyze the case of Mrs. M.

The ethical reflection part of this assignment will include your resolution or prudential decision making concerning the case. It should include citations from materials found in our texts that provide background literature, values, and principles that support your decision. Evaluate and apply both scripture and tradition to the case. This involves using the material in Medical Ethics: Sources of Catholic Teaching as a resource. Even if you do not share the Christian tradition, this process allows you to compare and contrast it with your own perspective.

The Case Analysis should be 1000-1200 words in length, formatted in MLA style, and include a works cited page.

1. The following questions can aid in the process of discernment or the gathering and the assessing of the



2. What is Mrs. M’s medical status, diagnosis and prognosis? How reliable are these?

3. Has there been a second opinion?

4. What treatments are possible?

5. What is the probable life expectancy and condition of the patient if treatment is received?

6. What is the probability that treatment will benefit the patient?

Patient Preference:

7. Is Mrs. M. competent?

8. Has she been informed about her condition and how?

9. Has she had time to reflect on treatment alternatives?

10. Has she made a clear statement about her wishes?

11. Does she have a written statement about her wishes, a durable power of attorney or living will?

12. If there is no clear statement, is there anyone who knows what the patient desire?

Views of Family and Friends:

13. Are there family members and friends?

14. Do they understand the patient’s condition?

15. What is their position and do they agree with one another?

16. Does any one have primary responsibility or legal custody?

17. If the patient is a minor, are they choosing what is in the child’s best interest?

18. Are there problems of communication with the family or friends? If so, can someone be found (a

19. minister) who could help?\

Views of the Care Givers:

20. Are the care givers fully aware of the facts?

21. What are their views and what are the reasons for them?

22. If there are differences, what is the cause of these?

23. How might the differences be resolved?

Legal, Administrative and Other Factors:

24. Are there laws that apply to the case?

25. Is there potential liability to the providers?

26. Are there any hospital guidelines that apply, i.e., Catholic Health Care ethical norms?

27. Are there others outside the hospital system that should be consulted?

28. What literature would it help to consult on this case?

29. Is expense to the patient and family a factor in this case

PHI 324 – Case Study The Case of Mrs. M Mrs. M was a 54 year-old woman who was transferred to a tertiary care hospital’s critical care unit from a community hospital. She had been diagnosed with an acute anterior wall myocardial infarction (heart attack). Secondary diagnoses were acute pancreatitis, disseminated intravascular coagulation, acute respiratory failure, and lactic acidosis. She was placed on a ventilator. Due to medication and her serious medical problems, she was only periodically alert, but responsive when directly addressed. There were no written advance directives. She was hospitalized in 1990 for acute pancreatitis. She also had a history of anxiety and depression, which were treated by Haldol and Prozac for several years. She had attempted suicide about 10 years ago. Her husband and daughter (Martha), were supportive. A son was kept out of the decision-making process because of a history of depression and the fear that he may harm himself. Mr. M and Martha voiced agreement that Mrs. M should make her own decision regarding treatment or withdrawal from the ventilator. Mr. M said his wife had spoken about potential end-of-life situations. She was clear that she did not want to be kept alive if the quality of her life would be more compromised than it already was. For the first three days of hospitalization she was aware and responsive. She was presented with the possibility of pancreatic surgery to relieve her from the terrible pain she was experiencing, and told that the surgery was high risk with a 50 percent chance she could die in surgery. Recovery would require extensive respiratory care, which meant time in an extended care facility. She was also informed that she now required dialysis. She declined the surgery and dialysis expressing a desire to be withdrawn from the ventilator. The physician agreed to her request, which had the support of Mr. M and Martha. On the fourth day of hospitalization, the doctor had a conversation with Martha and hesitated on withdrawing the ventilator. He called for an ethics committee consult. He became concerned about Mrs. M’s age and potential to rally medically. He was also concerned about her past history of depression, and wondered whether she desired a kind of physician-assisted suicide. He also began to question her competence and/or decision- making capacity. Mr. M and Martha were angered at this decision-making reversal and the consult with the ethics committee. They had told Mrs. M that her decision would be honored and they were in the process of already struggling with the grief that would be inevitable. Such ambivalence caused even more conflict and anxiety. (Adapted from Kuczewski, M. & Pinkus, R. An Ethics Case Book for Hospitals: Practical Approaches to Everyday Cases. Washington D.C.: Georgetown University Press, 1999)