Applied Ethics

Mr. Hardwick is 85 years old and has been hospitalized for 10 days. His diagnosis is bacterial pneumonia, secondary to gastric aspiration. He has a history of Chron’s Disease, rectal cancer, congestive heart disease, and now recurrent pneumonia. Mr. Hardwick’s medical care has cost in excess of $1.1 million dollars over the last 5 years. His insurance is Medicare. He has an “Advance Directive” that says he doesn’t want to be kept alive via artificial means (i.e., if he is terminal, he does not want intubation, food, or hydration). Although his pneumonia is resolving, Mr. Hardwick is mostly non-responsive (he wakens and has reflexes, but no interaction nor cognitive function). Feeding is his current acute issue. Nasal tube feedings have been unsuccessful. Due to severe reflux, multiple abdominal surgeries, and severe heart issues, surgery to install a permanent feeding tube has been judged to be too risky–doctors believe he will die in the operating room and have, instead, recommended hospice care. His family has now threatened a lawsuit because they are shocked and dismayed that the doctors are “starving him to death.”
Using specific ethical terms from your book, course content, the CMSA Standards of Practice for Case managers and reputable internet sources, answer the following questions:
1. Is withholding or withdrawing nutritional support from a person ethically justifiable? If so, under what circumstances? In other words, if it is justifiable, what are the criteria used to determine if nutritional support should be withdrawn?
2. What is the role of the patient’s wishes versus the family’s wishes in this situation?
3. What is the appropriate and ethical role of a Case Manager in a situation like this?

Discussion Requirements:
1. Your written response should be at least 500 words. You must use concepts, theories, facts, etc. from your book AND/OR the other sources listed above in your discussion and you must cite them.
2. Twenty total points are possible for the written part of this discussion.

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0=no posting

1-7=simplistic posting; short; no insight; repetition of others; questions only; inaccurate use of course content, theory or fact; missing parts of assignment; poor writing
8-14=more interesting posting; shows some thought; moderate insight; some inaccuracies, but uses course content, theory or fact; missing parts of assignment; good writing
15-20=interesting; provoked meaningful discussion; thoughtful; all parts of assignment complete; good insight; accurate and complete use of course content, theory, or fact in posts AND replies; excellent writing
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