Ethics in Nursing- Scenario #4

Whose Wishes Should Be Honored?

Mrs. Ryan, a frail 85-year-old woman who lived alone, was admitted to a geriatric psychiatric unit because of irritability, confusion, and increasing incontinence. Mrs. Ryans family stated that she continually refused assistance from her home health aides and became angry when her family and home care nurses tried to reason with her about these refusals. The patients family had installed child gates in her home to block her entry into her bathroom, trying to force Mrs. Ryan to use a bedside commode. Mrs. Ryan began having frequent accidents of incontinence on the floor near the bathroom door while trying to get through the gates. During her hospital admission, a couple of her medications were adjusted, and she subsequently became calm and cooperative with the care she received while in the hospital. When the RN and social worker talked with Mrs. Ryan about the safety risks of her living in her home alone, the patient stated, I am 85 years old and think that I should be able to decide how I want to live the remainder of my life. Im willing to take my chances. Mrs. Ryan was often unsure about the correct day of the week when questioned; yet she knew the name of the hospital and the reason that she was admitted for treatment. She was often confused about the names of the hospital staff but was able to state her own name. Her family continued to insist that Mrs. Ryan be admitted to a long-term care facility and requested that the psychiatrist complete the paperwork so that a judge could have the patient declared incompetent. The psychiatrist did not usually seem sincerely interested in his patients, and he had spent little time with Mrs. Ryan. This psychiatrist was usually willing to comply with families wishes. The RN and social worker disagreed with the decision to declare Mrs. Ryan incompetent and were in favor of allowing her to return home as she wished.

Taken from:

Rich, K. L. (2005). Ethics in geriatric and chronic illness nursing.

In J. B. Butts & K. L. Rich (Eds.),Nursing ethics: Across the curriculum and into practice. (p. 200). Sudbury, MA: Jones and Bartlett.

Questions for discussion

1. What ethical principles are important in this case?
2. How would you use ethical theories to assist you to make a decision?
3. What should be done in this situation?
4. What helped you to decide?