Question

refuting it. SCENARIO 1 Mrs. O is a 78-year-old widowed woman admitted to the hospital with acute gastrointestinal pain. Her doctors conduct an ultrasound, and they find a mass in her gastrointestinal tract. She consents to have it biopsied. The results come back, and her doctor informs her that she has a metastatic form of cancer that will spread rapidly without aggressive chemotherapy. Mrs. O'S doctors strongly suggest she begin treatment immediately, and her palliative care team devises a plan to manage her pain and keep her comfortable throughout the process. Mrs. O, however, States that she does not want to pursue chemotherapy. She claims that she understands she will die without the treatment, but she says that she wants to enjoy her remaining time with her children and grandchildren without the side effects of chemotherapy. Mrs. O's son, who visits her at the hospital several times a week, informs her medical team that since her husband's death last year she's "not been quite right." Mrs. O does not have a psychiatric diagnosis, but she mixes up the names of her doctors frequently and cannot remember when she's been given medication by her nurses. Mrs. O's medical team questions whether she understands and appreciates her diagnosis. Because they are morally distressed about the idea of not treating her cancer, they call for an ethics consultation, and you are assigned to the case. 1. How can we assess Mrs. O's decisional capacity? 2. Should her wishes be overridden, or should she be allowed to refuse care? SCENARIO 2 There is a nationwide outbreak of swine flu. The hospital where you work as an ethicist has admitted 5 patients to the ICU who have symptoms of the swine flu. This form of the flu is particularly dangerous for children, the elderly, and those with compromised immune systems.

Answer 1

1. We can assess Mrs.O's decisive capacity through some specific tests and if she passes them then only we can tell that she understands and appreciates her diagnosis. In certain cases the person passes some tests and fails some then he or she is referred to ta psychiatric doctor to determine whether the person is mentally stable or not.

2. In this case if she is mentally unstable then the doctors should talk to her immediate guardian or relative that is in this case is her son. Only after the consent of her son she is allowed to refuse care.