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Case Study Seventy-Four: Ethical Issues over DNR Orders

Introduction:

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Mr. Warden, a 93-year-old white male, is admitted to Centerville Community Hospital from Centerville Estates Nursing Home. Mr. Warden has had multiple strokes and is only partially responsive to painful stimuli. He does not recognize or respond to nursing staff, physicians, or family members. In addition, he has flexion contractures and a large infected decubitus ulcer over his left sacral area. Further evaluation shows Mr. Warden has extremely poor heart function and is in congestive heart failure. The notes from Centerville Estates Nursing Home indicate Mr. Warden has had one visitor in the past six months; that visitor was not a family member.

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Discussion Questions

  • What are the facts in this situation?
  • Autonomy, nonmaleficence, beneficence, and justice are the cornerstones of ethical decision making. What ethical dilemmas does this case illustrate?
  • Have any principles of ethical decision making been violated in this case? What ones have been supported? How might our cultural upbringing, personal assumptions, and opinions influence our decisions as health care managers? Provide rationales for your responses.
  • Based on what you know from this short case; why do you think Mr. Warden’s daughter is so insistent on wanting “everything” done for her father?
  • What if Mr. Warden was wealthy and had a large estate? Would that change your opinion of the son and his responses? Provide a rationale for your response.
  • If the son had no power of attorney, how could this issue be resolved? Can a physician decide to withdraw care without the consent of the family? Who has the final say in the care of a patient in this condition? Provide your reflections and personal opinions as well as your recommendations and rationale for your responses.

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