• Discuss the knowledge needed to understand the person in the environment to work with this family.
• Apply strategies of ethical reasoning to arrive at principled decisions that may arise within this case study.
• Identify how to tolerate ambiguity in resolving ethical conflicts.
• Explain any foreseen areas of difficulty this family may have in moving forward with the treatment goals you have developed and how you would manage these areas.

Reference: The Case of Marie

Marie is 68 years old and is part Scottish and American Indian. She lives in a town that provides a sense of security for her because she lives close to her two daughters. Before her moved she lived in the same little rural town for majority of her adult life.

She started out working for others and in her late 30's decided to stop working for others and open her own business. That business was very successful but required long hours and hard work. She derived a sense of accomplishment from her business that could not be matched at any time in her life. She loved the interaction with others but could no longer keep up with the physical demands from the business. She retired 3 years ago. Marie is not wealthy but is capable of maintaining her home and lifestyle. She reports that now that she is retired she likes to read and feels most comfortable in her own home.

She currently reports feeling like she has no purpose. About 5 years ago her best friend and husband died of cancer. She and her husband had been married for 47 years at the time of his passing. She was profoundly shaken by this loss. Upon assessing her living arrangements at the time of his death, decisions were made in consultation with her two children to sell the business and move closer to her daughters. The move has been a positive and negative impact - positive due to the being around others who care for her yet negative due to the stress of being around younger children. She reports becoming depressed and anxious around the anniversary date of her husband's death.

Marie has two children Lisa who has just turned 50 and Toni who is in her mid 40's. Both Lisa and Toni have young children of their own. Lisa who is a single mother by choice with twins who are 4 years of age. Toni who is married and has one child who is 5. Both children live close by and visit often. When they do visit, Marie complains that the children make her stressed and tired. Lisa and Toni are concerned about their mother's ability to tolerate the activity of the children. They want their mother to enjoy her grandchildren as much as possible.

Lisa is dependent on pain medication due to an injury that she encountered at work several years ago. She still functions fully as far as work and social life. She has challenges with the twins that she is raising and yells at them frequently to the point where one of the children is beginning to yell back at her and become defiant. She frequently asks for assistance from Marie with the children. The preschool has reported that this same child is having difficulty with social relationships, emotional connections but reports no negative behavioral issues.

Toni lives with her husband of 10 years and her daughter who is 5 years of age. Marie reports that Toni is supportive of her and provides emotional support when needed. Toni has been caring for her mother during the medical procedure that has been recently conducted.

Marie has just recently undergone an extensive knee replacement and is in physical therapy to regain her mobility. She has been taking prescription drugs for pain but refuses to take them as directed by the physician due to her experience with Lisa. She takes the pain medication only if she is in debilitating pain. Marie often reports having difficulty with her memory because she has to check on things more often such as closing the garage door when she leaves, or to check to see if she has locked the door before bed etc. She is extremely concerned about losing her cognitive abilities.

Toni has privately asked for your help in looking for an assisted living facility for Marie-she believes her mother is having increasing difficulty living on her own, and doesn't feel she can provide consistent aid. She also thinks her sister is taking advantage of her Marie's availability to watch her children. Lisa has privately urged you to convince her mother to start taking her pain medication, as well as asking you to help explain to Marie how beneficial it is for children to have a grandparent involved in their lives. Marie has recently told you that she thinks Lisa may have taken an unopened bottle of her pain medicine.