A 70-year-old retired lawyer has continued complaints of indigestion, dysphagia, loss of appetite, and weight loss. He goes to his primary care physician and has extensive testing over several months without symptom resolution. The patient becomes distraught over severe weight loss, pain, and an inability to diagnose. He attempts suicide by chest stabbing and is admitted to the hospital. Additional tests identify a mediastinal malignancy, which may be treatable (outcome uncertain)

When the patient is informed of the diagnosis and prognosis, he requests hospice care. Psychiatry follows closely for capacity in decision-making and finds the patient to have capacity on a consistent basis.

What ethical problem is represented in this case (for the provider)?

What bioethics principle is present? (for the providers

• Identify the ethical problem presented (ethical distress type a or b, ethical dilemma, locus of authority. (2 pt)
  • Ethical distress (moral distress) type A: constraint
  • Ethical distress type B: uncertainty
  • Ethical dilemma: two or more acceptable but mutually exclusive courses of action
• Identify an applicable bioethical principle (2 pt)
  • Autonomy (exercising or respecting personal freedom)
  • Beneficence (doing good)
  • Non-maleficence (doing no harm)
  • Justice (distributing benefits to those deserving of the benefits