Healthcare Ethics: Reflections and Discussions

Please take the time to reflect on and discuss the two assigned articles with your fellow group members and respond to one of the following questions. Please post your response as well as your reply to one of your fellow group member’s posts online via Moodle.

1. Please discuss Fisher’s argument regarding structural violence with regard to the subject of paid participation in research. Are participants who engage in such activities exercising their autonomy or do material conditions, e.g., poverty, exert a coercive influence?

2. Please discuss Kelleher’s arguments with regard to government’s responsibility to care for its citizens. How would Kelleher classify attempts to create a two-tiered healthcare system in Canada to help alleviate wait times?

Once you have read the materials for the lesson, please complete the following case analysis and post it online for review and grading by your  fellow group members. Analyses must not exceed 3  double-spaced pages. Each analysis is worth 5 points and will be graded by your fellow  groupmembers, who must assign a grade from 0 to 5, based on the thoroughness of the response. You  should cite relevant material in the  assigned course readings as appropriate. You are also welcome to consult external sources but must provide proper references for any  quotation or citation from external sources. Once you have completed grading the assignments please have one group member email the  grades to me. Each individual case analysis will be worth 5 points.

Case: Alan underwent emergency coronary artery by-pass surgery 10 days ago, and since then, his condition has remained critical. He has never completely regained consciousness. Owing to a lung infection, he remains on a ventilator under heavy sedation. In the past week he has developed one complication after another—total body sepsis, a life-threatening arrhythmia, hypertension, and some liver failure—for which he  has received a number of drugs. Now he is in kidney failure and requires dialysis.

His family has been at the hospital since Alan’s ordeal began. They have been allowed only short visits twice per shift. The nurse and doctor now inform them of the kidney failure and leave them alone to discuss whether they should consent to dialysis.

Alan’s family knows his prognosis is poor. They also know he would not wish his life to be extended in this way. They believe he has suffered enough, and decide to refuse this dialysis, knowing he will die. They request a meeting with the team to discuss their decision.

While visiting Alan a short while later, his wife notices that he is still receiving drugs to maintain his blood pressure, as well as the antibiotics that so far have not improved his condition. Further, the nurse informs her that because Alan’s potassium is elevated, he will be given calcium polystyrene enemas in an attempt to bring it down.

The family is distraught. Together, they gather the courage to tell Alan’s nurse that they do not wish to subject him to these enemas which, if effective in the short term, will only prolong his dying. Further, they insist that the drugs be discontinued, and that they be allowed to remain with him in privacy.

Alan’s nurse supports the family’s position and communicates their wishes to the physician on call. The family is permitted to stay with Alan until he dies peacefully a short time later.

1. How did this case evolve to the point where Alan’s family needed to advocate on his behalf?

2. How could this situation have been avoided?

3. What process would have resulted in a better outcome for everybody?

4. What rights did Alan and his family have?

5. Were these rights respected?

6. Identify the contradictions in this story.

Please read Case 2: Disagreement About Treatment Decision-Making found on pp. 97-103 in Yeo and colleagues’ Concepts and Cases in Nursing Ethics and answer the related questions on p. 103. Your analysis should take the form of an essay in which you devote 5 double-spaced pages to answering the questions. As there are 4 case analyses you are expected to rotate authorship of the case (i.e., you should take turns coordinating the group discussion and writing up the case analysis). You will submit each group case analysis online via Moodle and will receive a common grade. You should cite relevant material in the assigned course readings as appropriate. You are also welcome to consult external  sources but must provide proper references for any quotation or citation from these sources. Each group case analysis will be worth 10 points.