As a nurse working in an inner city medical center hospital, you take care of many underserved patients. On rounds with the gynecology oncology
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As a nurse working in an inner city medical center hospital, you take care of many underserved patients. On rounds with the gynecology oncology team, you meet Ms. D., a 33-year-old white unmarried woman with Stage IIIC ovarian cancer. Ms. D. has refused all offers of chemotherapy treatment for ovarian cancer that has now spread throughout her abdomen and inguinal nodes. She has malignant ascites and a bowel obstruction. Her condition has worsened to the point that she has to have daily paracenteses and the team has told her that they may have to operate to partially alleviate the obstruction.
She tells you she has schizophrenia and she hasn’t taken her psychotropic medications in a while because “they’re poison.” She tells you, “I may be crazy, but I’m not stupid. That treatment is going to kill me. I don’t want it.” The treatment team tells her that treatment is her only chance of curing her cancer, and they will contact her family against her wishes to make sure she gets appropriate treatment.
Assignment Questions:
1. What ethical principle(s) is/are at issue in this case?
2. Should an ethics consultation be requested?
3. What advocacy roles do you have as the oncology nurse taking care of this patient?
4. Do you think Ms. D. is capable of being her own decision-maker? If not, what resources does your hospital have to assist in appointing a DPOA (Durable Power of Attorney) or guardian (social services, patient advocates, relationship with state Ombudsman)?
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