Assignment: Pick one of the case studies that follow and read  the story and then answer the questions that are listed below the story.

Case #1:

Mr. B.: Family Conflicts

Mr. B. is a 21-year-old African-American male who has been treated  over the last year at your hospital for widely metastatic Burkitt’s  lymphoma. Mr. B. had lived at home with his mother, but a few months ago  against his mother’s wishes, he married his long time 17-year-old  girlfriend who is the mother of his 2-year-old son. His mother does not  get along with the patient’s wife. The couple have a small apartment and  his wife has been trying to keep working nights as a nurses’ aide to  support them. He’s applied for disability, but they currently have no  consistent source of financial support except her part-time job.

Unfortunately, after his first course of chemotherapy, he became  septic and nearly died in the ICU. His disease has continued to progress  through second and third line treatment, and he has been hospitalized  almost continuously for the last two months for dehydration and fevers,  among other problems.

He has been evaluated for bone marrow transplant, but has steadfastly  refused it because “I don’t want my family to lose everything because  it’s probably not going to work at this point.” He has told you that he  was pressured by his mother to have the evaluation: “It’s really hard to  say ‘No’ to her. Mom told me she’d take the hospital to court, if they  don’t do a full court press. She’s already contacted a lawyer. My wife  can’t stand up to her, so I guess I’ll end up doing it even though I  don’t want to.”

Questions:

1. What ethical principle(s) is/are at issue in this case?
2. Does this situation warrant an ethics consult from the hospital ethics committee? If so, who should initiate it?
3. What, if any, legal issues should be examined?
4. What patient/family issues should be addressed?
5. What advocacy role do you have as the oncology nurse taking care of this patient?

Case #2:

Ms. D.: Patient & Interdisciplinary Team Disagree on Treatment

As a nurse working in an inner city medical center hospital, you take  care of many underserved patients. On rounds with the gynecology  oncology team, you meet Ms. D., a 33-year-old white unmarried woman with  Stage IIIC ovarian cancer. Ms. D. has refused all offers of  chemotherapy treatment for ovarian cancer that has now spread throughout  her abdomen and inguinal nodes. She has malignant ascites and a bowel  obstruction. Her condition has worsened to the point that she has to  have daily paracenteses and the team has told her that they may have to  operate to partially alleviate the obstruction.

She tells you she has schizophrenia and she hasn’t taken her  psychotropic medications in a while because “they’re poison.” She tells  you, “I may be crazy, but I’m not stupid. That treatment is going to  kill me. I don’t want it.” The treatment team tells her that treatment  is her only chance of curing her cancer, and they will contact her  family against her wishes to make sure she gets appropriate treatment.

Assignment  Questions:

1. What ethical principle(s) is/are at issue in this case?
2. Should an ethics consultation be requested?
3. What advocacy roles do you have as the oncology nurse taking care of this patient?
4. Do you think Ms. D. is capable of being her own decision-maker? If  not, what resources does your hospital have to assist in appointing a  DPOA (Durable Power of Attorney) or guardian (social services, patient  advocates, relationship with state Ombudsman)?