Due Week 3 and worth 250 points

Deciding to place a loved one into a long-term care facility can be extremely difficult. Even more difficult is the thought of your loved one’s rights being violated while in long-term care. Patient healthcare rights are not as clearly defined as one would expect, and there are long-term care and other healthcare facilities that create their own sets of patient rights. However, there are also certain indisputable rights afforded to patients across the board.

Read the case study titled “A Legal and Ethical Dilemma”, located on pages 463-465 of your text. Next, use the Internet or Strayer Library to research information on a patient’s right to die.

Write a four to six (4-6) page paper in which you:

1. Describe the legal and ethical dilemma discussed in the case study. Analyze the key ways in which a patient’s right to die relates to this specific case. 
2. From your research, specify the potential repercussions for failure to comply with the wishes of a patient who has requested to withhold a life-sustaining procedure. Next, take a position on whether the patient’s right to die or the patient’s right to be protected from harm should take precedence in this case. Provide a rationale for your position.
3. Imagine that you are a part of the ethics committee investigating this case. Determine the main facts pertaining to the issue that the committee should consider. Suggest one (1) step that the facility should take next in order to resolve the dilemma. Provide a rationale for your response.
4. Use at least three (3) quality academic resources. Note: Wikipedia and other similar websites do not qualify as academic resources.  

Your assignment must follow these formatting requirements:

• Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow APA or school-specific format. Check with your professor for any additional instructions.
• Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length.

The specific course learning outcomes associated with this assignment are:

• Identify the factors that have led to the current realities of long-term care in the United States. 
• Assess the various stakeholder groups of long-term care along with the nature of the relationship(s). 
• Evaluate the impact of litigation on long-term care providers and practices. 
• Use technology and information resources to research issues in long-term care management.
• Write clearly and concisely about long-term care management using proper writing mechanics.

Case Study

Case 2

A Legal and Ethical Dilemma

Contributed by Alan S. Whiteman, PhD, FACMPE, and Lisa E. Sliney, MS, LNHA, Barry University

Background

Mary Evelyn Greene, who has memory impairment, lives in a private room at Shady Brook Skilled Nursing Facility located in a beautiful suburb of a major metropolitan city. She has resided at Shady Brook for the past 18 months. Before moving into Shady Brook, Mrs. Greene lived independently in her own home with assistance from a private-duty nursing assistant and a housekeeper. She and her husband had resided together in this home for more than 50 years. Mrs. Greene is 89 years old and suffers from several health problems associated with aging.

Mrs. Greene has one son, David Greene. David has the power of attorney to handle his mother’s health care and other personal affairs. David works as a trial attorney in one of the city’s largest and most prestigious law firms. He owns a large home in an upscale neighborhood and works hard to put two of his children through college and another one through medical school. His home is about an hour’s drive from his workplace and about 20 minutes from Shady Brook. David’s wife Barbara has never been close to her mother-in-law and has not shown much interest in her care. Hence, caring for his mother has become a major responsibility for David, and he is having a difficult time dealing with her declining health and the onset of mild dementia. It is becoming increasingly more difficult for David to leave his law practice or the court room to deal with issues related to his mother.

Mrs. Greene’s husband was a very successful land developer who left her with a substantial estate, which meets all of her financial needs. After her husband passed away, Mrs. Greene decided to remain in her home. She was able to maintain her independence until she was 87 years old, when she began to show signs of dementia. Shortly thereafter, David moved her to Shady Brook. David also hired a part-time “sitter” to keep her mother company because she was too weak to go out of her room on her own. Mrs. Greene seems to enjoy the sitter’s company and likes the attention she gets.

Upon entering Shady Brook, Mrs. Greene became depressed over losing her independence and her home and felt a growing frustration with forgetfulness. She gradually lost her appetite, and her desire to eat continued to decline. On the other hand, Mrs. Greene seems to enjoy the smell of certain foods. The associates monitor and document her food intake and her facial expressions when she is offered different foods. Mrs. Greene is particularly fond of Susan Brown, a certified nursing assistant (CNA), who sits with her and helps Mrs. Greene with whatever little she can eat. When this occurs, her appetite shows some improvement. Mrs. Greene also responds well to volunteers who carry out activities at the facility.

Frustrated Family Member

Mrs. Greene has become too weak to eat on her own. When no one is feeding her, she leaves most of her food on the tray. Recently, she has sustained a weight loss of more than 5 pounds per week. Her plan of care needs to be reevaluated, and her situation needs immediate attention.

David has been visiting his mother quite regularly. Recently, however, his visits have become less frequent, generally two to three times per week. The associates who work on Mrs. Greene’s nursing unit have reported some changes in David’s attitude. At one time he became angry with his mother, raised his voice, and spoke to her as if she were a bad child. Although no one was present in Mrs. Greene’s room at the time, the associates working at the nursing station heard David’s loud voice. When the charge nurse went into Mrs. Greene’s room to find out why David was angry, David told her that it was none of her business. On David’s subsequent visits, the associates observed that Mrs. Greene would become agitated during David’s visits. These issues were brought to the charge nurse’s attention, and they were documented in the patient’s medical record.

The Dilemma

One day David approached the charge nurse and exclaimed that his mother had expressed that she wished to die. On his next two visits, David also told the CNAs that his mother’s desire was not to eat anything so she could just die a quick death. This was the first time the CNAs had heard that Mrs. Greene had expressed a desire to die. The associates also believed that Mrs. Greene appeared to be happier when David was not there.

Before the week was over, David came into the facility early in the morning on his way to work. He handed a sealed envelope to the incoming charge nurse on the day shift. The envelope was addressed to Betty Wright, Shady Brook’s administrator. David said to the charge nurse, “I have been telling you people that my mother wishes a speedy death. Tell your administrator that I will be filing a lawsuit if my mother’s wishes are not carried out.” David left without visiting his mother.

Betty Wright decided to place the issue on the ethics committee’s agenda for that same afternoon. As a safeguard, Betty also notified the facility’s liability insurance carrier of the potential legal action.

Meeting of the Ethics Committee

That afternoon, Betty met with members of the ethics committee: chaplain, medical director, director of nursing, charge nurse, social worker, two CNAs, and the local ombudsman. Betty began the meeting with these remarks: “The man’s mother has been declining rapidly and eats very little. He wants his mother to die rather than prolong her suffering. I have learned that the son is the heir to his mother’s estate, and my overall concern is my trust in his decision or his motives. I think he needs the money to pay for the college expenses for his three children. Although it is not uncommon for some residents to be ignored by family after they are admitted, it is rare that they express the wish to enable the death of a relatively healthy person.” The ethics committee is faced with the issue of what is legally and ethically appropriate. The committee deliberates on whether or not to comply with David’s request to withhold food as well as the threat of a lawsuit.