boid_86

He was in his early sixties. He had been in a traffic accident and had come to us for rehabilitation. He had a nasogastric tube in. They wanted him to have a PEG (percutaneous epigastric tube). He realised that he would never be able to swallow anything again. This was because he had a stroke after his accident and was very limited in his self-care abilities. He also wasn't able to speak very well at all, but with a lot of effort he could write what he wanted, he was just able to do this. He had a much younger wife.. He said--or actually he wrote (because he couldn't really speak)--that he didn't want any intervention of any kind. No PEG, and no resuscitation or any other treatment if he had another stroke. But she (his wife) desperately wanted him to have every treatment possible. He (the patient) was begging the doctors and begging us not to have anything done. But the doctor wouldn't put a no-CPR order in his medical record. Wouldn't agree to it because the wife didn't want it. It was a horrendous situation. He (the patient) would write little notes to us saying things like "please no tube" and hold them out to us and put them in our pockets. Even though he had a stroke he appeared to be as mentally alert as you or I. The doctors said his quality of life wouldn't be too bad. He would go to a nursing home and be looked after and fed through the PEG. He would possibly be able to live for years like that, if he didn't have another stroke or something. He would write to his wife that he loved her but he didn't want to live like this. He would get really angry that he wasn't being listened to, and try to express himself verbally but couldn't, and she would sit with him and cry and say she couldn't let him go. It was such a stressful situation for everyone, the nurses were all so upset about it, but what could we do?"

I thought it is within the nurse's scope to tell the patient her result. I was told before that nurses are allowed to tell test results except interpreting them as it is the physician's responsibility.

Thanks Lori,actually I've had some disagreements with my collegues at work that's why I also want to know other people's opinion about this..to be honest I'm not good at these kinds of situations.

Hi my name is Nathan and I've got a moral reasoning report this wedsday..I need your help guys as the case is confusing for me.Here's the narrative case: Mrs Resevski has been admitted for falls & generalised weakness for investigation. She is 85, widowed, lives alone, but has 6 sons and daughters, grandchildren and great grandchildren, many of whom visit her regularly. She undergoes several tests and one of those is an abdominal ultrasound, the results of which show that she has a very large abdominal tumour. This finding is documented in her notes, but you are informed at handover that Mrs Resevski herself does not yet know, as her son has requested staff that she not be told until an oncologist can come to see her. Later that shift, Mrs Resevski asks you if her scan results are back yet and if so what they are. Assess the key ethical decision(s) that were/could/should and/or need to be made in this situation and the moral reasoning for them.