Registered Nurse's Case Study

Practicing as a case manager / registered nurse I had the pleasure of working with Mrs. K, who is an 88-year-old woman with advanced Alzheimer disease and Stage IV lung cancer, being cared for at home. Her son was distressed that her mother was no longer able to eat or drink. Feeding her became a battle and the son asked about placement of a feeding tube so that his mother could be fed without the stress of attempting oral feedings. This elderly lady did not have advance directives and became increasingly uncommunicative over the last months, but she had expressed in earlier conversations that independence and self-sufficiency were fundamental values for her and she did not want to have any tubes or catheters to sustain her life. The
In Mrs. K’s case, these acts of goodness included offering food without forcing it, scrupulous mouth care, and treatment of pain and other symptoms. Beneficence is to do good and those are the things that will be good for the patient given that artificial nutrition will cause more harm in this case. Doing good also includes offering support to the son regarding his concerns from social work and spiritual care that way he can feel reassured he won’t be hastening the death of his mom but rather doing something good and allowing the course of disease to happen and a natural death as his mom had
Although those aspects are an extremely important part of the decision making process, what certainly comes into play, are social, cultural, and religious concerns. Many of this concerns, as with the issue of withholding artificial feeding, are emotionally loaded and tension may exist between the involved parties and depending on the lens through which the situation is viewed. For example, maleficence versus beneficence —will withholding or administering artificial nutrition to someone close to death prolong or hasten death; increase suffering or provide any benefit?. The ability to acknowledge everyone’s emotions, validate them, and then step back to think systematically about all the possible options is part of the ethical and clinical decision making process. In Mrs. K. case, applying all the ethical principles and answering all the questions presented in each step helped me a lot in the decision making process and will be without any doubt a process I will be applying in practice. In this case we can also conclude that the best option will be to withhold artificial feeding and hopefully after acknowledging the patient’s son concerns, he will be able to honor his mom’s wishes and allow her to die as she