Help With Legal/ethical Case Study

[fd5151]

Please help with this case study assigned to me for homework; i have done some research on my own but would like to hear input from experienced nurses who may see things that i have not thought of due lack of experience:

"You are a registered nurse working in a personal care home. One of your patients is Mrs.B, a frail, 92 year old woman with severe arthritis, diabetes and moderate dementia. She has 2 very supportive daughters who would take turns visiting her on a daily basis and who would assist with her care. she was wheelchair bound due to severe arthritis but appeared to enjoy daily visits to the dining room to enjoy meals with other residents and appeared to enjoy the atmosphere.

Within 8 months of admission to the nursing home Mrs. B started to refuse solids and fluids. When staff or family would put food into her mouth she would just spit it out. The dietician was consulted in an attempt to alter her diet and include traditional foods that the family said she enjoyed in the past. when this was unsuccessful, a thorough medical assessment was done to rule out any medical reasons for her lact of appetite. Even though she had dementia she would say no when staff or family tried to feed her or offer her fluids. The situation lasted a month and she became malnourished and dehydrated and the family recommended that she be sent to the hospital. While in the hospital, Mrs. B continuously pulled out her IV tube, was labeled 'non compliant' by nursing staff, and a feeding gastrostomy tube was inserted. Mrs. B was then transferred back to the nurisn ghome where she was placed on a regime of tube-feedings every 4 hours. She continued to try and pull out the gastronomy tube. When staff members tried to reinsert the tube, Mrs. B would tell the staff to leave me alone!

Each time the family requested the tube be reinserted.

Clinically, Mrs. B was getting weaker and her prognosis was extremely poor. It was clear to the nursing staff that Mrs. B wanted to die, but her daughters were not yet willing to accept this. When the nurses suggested to the family that their mother appeared to understand what she was doing, the daughters stated that their mother was confused and didn't really know what she was doing."

Whew!

My question for the assignment was:

1)Identify and discuss all relevant ethical and legal principles in this case.

2) What guidance does the CNA code of ethics provide for this situation?

3) What good or harm may result from each option?

4) (the one i have the hardest time with) What good or harm may result from each option? And Are there any possible compromise solutions?

5) What do you believe is the best way to resolve this conflict?

Please help; any input would be greatly appreciated, perhaps some of you have had to deal with this very situation and know immediately what kind of resolutions can be provided and how the code of ethics guided your decisions?]

Thanks so much

[neneRN, BSN, RN]

I think you'll get better responses if you also post some of YOUR thoughts as to what direction you're taking with your answers...that way, we can maybe point out some different points of view/ideas/thoughts, etc. that you may be missing. (Otherwise, might come across as posters doing your homework, which I'm sure is not your intent)