Mark is a 75 year old Alzheimer's patient experiencing end of life care. He has an in-home nurse, so that he is able to be comfortable during this stage of his life. His nurse, JoAnn, wants him to be as independent as possible. So she helps Mark keep his autonomy by always asking him what he wants to wear, eat, and do everyday. Additionally, JoAnn makes sure that Mark understands his diagnosis and has a say in his treatment plans.
Mark's health has been declining rapidly for the past few months, and JoAnn knows that the majority of the time, Mark is not stable enough to make his own decisions. His doctor wants to continue with home health care and his medications, while JoAnn believes that it may be time to stop medication and hire hospice to make him more comfortable. JoAnn has worked with Mark for years and believes that she knows him really well, and would like to include him in this decision if at all possible. By including Mark in the decision, JoAnn is showing her loyalty and respect to Mark and demonstrating the principle of fidelity.
Mark has still been experiencing more symptoms of his Alzheimer's. JoAnn knows that she has a close relationship with Mark and she feels that a decision of whether Mark needs hospice or continue his in-home care is needed to be made quickly. She wants to sit down with Mark and have a conversation with him about what she thinks is right for him and what the doctor thinks is right. JoAnn knows that Mark is sick and cannot make decisions on his own, but she is going to take in consideration of what Mark wants and relay it to the doctor so they can make a decision based on what Mark wants for himself. JoAnn is showing the relationship approach by always hearing what the patient wants instead of her and the doctor making the decision for the patient without talking to them first.
Since the decision of whether Mark needs hospice or continues in-home care may take a while to decide, the doctor prescribes a stronger medication for Mark since his health is declining so quickly. JoAnn notices that the medication is making Mark act different than he has been since she's been taking care of him. He's told her multiple times that he feels dizzy and she's also noticed that he stays in bed all day ever since he's been on this new medication. JoAnn knows that what the doctor has given Mark is affecting his mobility and his mental health. She wants to do the right thing for Mark by talking to the doctor about the new medication and switch back to the old medication. By talking to the doctor and doing what is right for Mark, JoAnn is portraying beneficence.
JoAnn is worried that if Mark continues to take the new medication, he will not live much longer. She wants Mark to have hospice, but does not want that decision to be made from the affects of the medication he has been taking. JoAnn talks to the doctor about switching back to the old medication and the doctor is hard to convince. She tells the doctor about how the new medication is making Mark feel and the doctor finally agrees with JoAnn. Mark is put back on the old medication and is able to get out of bed and not show any signs of dizziness. JoAnn did not give up on getting Mark the medication he needed. She has shown the principle of justice.
JoAnn has worked with Mark for years, and would like to continue to be his nurse for as long as possible, but she knows that even though Mark has improved with the switch of medication that she may not be able to do much for him in the near future. She and the doctor agree that Mark would be more comfortable with hospice. JoAnn discusses this option with Mark, expressing that she will be sad to leave, but that hospice will take good care of him. JoAnn uses the Ethics of Care Approach by showing Mark how much she cares about his health and well being by admitting that hospice is the best option.