Molly is a 29-year-old with advanced cancer. She has decided, in consultation with close family members and friends that despite the severity of her illness and its symptoms, she does not want any treatment. To ensure that her wishes are respected if she loses the capacity to make choices and consent to recommended treatments and care, Molly has prepared an advanced health directive. In her advanced directive, she has outlined a comprehensive list of medical treatments and nursing care that she does not want and, if she were competent to decide, would refuse. The healthcare team involved in her care is unanimous that, at the time of preparing her advanced health directive, Molly was competent to make decisions and ‘knew what she was doing’.
You are a community nurse visiting Molly at home and notice, with concern, progressive deterioration of her condition. She has noticeable difficulty walking and is at risk of falls. You arrange for her to have a personal alarm system in place, but she refuses any additional support services. She also refuses a range of essential nursing interventions that would help to make her more comfortable, including mouth care for a mouth infection, bowel care for constipation and wound care for various superficial cuts and abrasions that she sustained following a recent fall, which have become infected. Workers from other services who come in to assist Molly are also becoming increasingly concerned about her condition, and report this to your team.
1. Outline two key ethical principles raised by this case study?
2. Considering the duty of care of the registered nurse in this situation and justify your reasons, should you and the team override or respect Molly’s wishes? This section must be supported by the literature.
3. In either case, discuss the reasons you would use to justify your critical thinking and decisions. This section must be supported by the literature
4. Discuss strategies to address the ethical issues raised in the case study in order to work through the situation. This section must be supported by the literature.