Collectively, answer the questions at the end of the case. Tie back to appropriate readings, current events, your professional knowledge, previous blog posts, etc. Respond to at least one of your classmates' postings.
I feel like his children and the health-care professionals are making an unjustified leap in regards to his long-term care. First of all, they should not be sedating him in forms of a restraint because of his behavior. Second, he may have intermittent confusion, however he must be deemed legally incompetent in his decision making in order for his family or health-care professionals to make him go to the nursing home. I do not feel it's morally permissible to make him go to the nursing home, however they do need to make sure he has a safe discharge. They need to consider alternative plans other than long-term care that he is agreeable to.
I agree. They need to offer him possible options other than nursing home. The care coordinator or social worker would be a great asset to help assist him in his discharge planning.
I think the hospital is wrong for sedating Ronald to make him compliant with their plan. I do think he needs a safe discharge plan. I case study doesn't really go into how often he has these confused periods or how long they last. There are other options for him. Why didn't they suggest senior housing or assisted living. A place like that Ronald would be able to maintain his independence while someone would be able to see his comings and goings. Sounds to me like Ronald would pass a mini mental so therefore he should be able to be involved in the decisions made regarding his care.
Sometimes I think it is hard for people to look at their aging parents who want to continue to make decisions about their life and they want to remain as independent as possible even when it may not always be in the aging parents best interest. We often avoid having these discussions prior to or in the event that something could happen. It is not a discussion that people like to have but I think is often necessary.
Sedation is a form of restraint that is one of the last resorts to make the patient safe to self and others. If the patient is not a harm to self or others, sedation should not be an option of treatment. The facility is not following professional standards of practice that are defined from professional organizations such as JACHO. Ronald X or his family could actually pursue to prosecute the facility for not abiding by the professional standards of practice guidelines especially if the patient is deemed mentally compentant. The health care professionals should not be obligated to follow the paternal model as their primary bases of care. The health care providers in this case are not the parent of the patient however; they should advocate for him, discuss a mutual goal and grant his wishes. If the health care professionals are apprehensive about his plan, the health care professionals should report their concerns to adult protective services to investigate. This would demonstrate the willingness of the health care professionals to respect the patients’ rights, provide alternative solutions and what I believe is doing what is morally correct.
We all know that there are alot of options to keep patients out of nursing homes and in their own homes now days;. I think the family would have no problem with the hospital sedating him because they are going with what they want to happen to the patient.
I do not agree with the decisions of the healthcare workers sedating Ronald X to be able to go through with their plan of sending him to a nursing home. I understand the concerns that the family may have but sedating a patient for these reasons is very immoral and wrong. Ronald X appears to be only intermittently confused so placing him in a facility without his consent and against his wishes is not right. In this situation there needs to be other plans to keep Ronald safe while at home.
I agree that placing Ronald in a facility is not right. Also something to consider is the fact that along as Ronald is alert and oriented he would have the legal right to sign himself out of the nursing home should he be placed there. Then what has the family and/or hospital gained in this case?
I also agree putting Ronald in a nursing facility is not the right thing to do. He is still able to make choices and no one should be able to stop his legal right to do so.
Chemical restraints? Never the answer to making the right choice. Could the confusion be caused from medication or an infection? Were these things even taking into consideration? I think other possible causes of the confusion should have been explored.
I am not in agreement with the hospital to sedate Ronald X so he will be compliant to be discharged to a nursing home. I can understand the family's concern for his safety and well being, but that is ethically and morally wrong. I do not understand how his children would allow this to happen, and knowing that he does not want to go to a nursing home, want to send him there anyway. They need guidance from social work to accommodate the family as a whole. They need to be made aware of other facilities such as assisted living or adult day care so he can be attended to, if the family have work obligations.
I agree Tricia, sounds like social work wasn't every involved in discharge planning. There are so many options available they should have been able to come up with one that could have pleased everyone with a little compromise.
Like most of the other posts I believe that it is also wrong to sedate the patient. Sedation is a form of restraint that should be used only as a last resort to keep the patient from harming himself or someone else. I feel like the family or health care professionals are not listenting to what the patient wants. If I were the patients nurse i would have social services come in and help the patient and family make the right decisions. There are many options avaliable that wouldn't require the patient going to a nursing home.I would reject the patenalism view on this case because even though they are trying to do the patient good and keep him safe they are taking away the patients autonomy.
I think getting social service or adult protective service is a great idea. They can assess the patients needs, provide resources and determine what is needed for the patient.
I agree. Social service or adult protective services should be contacted in a situation like this. Forcing him to go to a nursing home is wrong. And if the family is pushing for that APS needs to be involved.
Sedating a patient to ascertain compliance is morally wrong. While I understand the point of the family in their fears for Ronald's safety, they have not exhausted all possibilities for this patient , and infringing on his rights to decide for himself is morally reprehensible. They could consider bringing a part-time caregiver to his home, local churches sometimes have people willing to come sit with the elderly, community resources often provide adult day care programs, and their are most likely assisted living and senior housing programs they could look in to. Taking away the autonomy of someone who still has the capability to make his own informed decisions is not the way to approach Ronald's situation.
I agree sedating Ronald was morally wrong. I like your ideal of bringing in a part- time care giver. Using an outside resouce can make all the difference.
I see lots of creative problem-solving in these posts. I remember a hospice chaplain once saying that she would ask family if they could support a decision even if they didn't agree with the particular decision.
You didn't read it, but there is a book called Being Mortal, which is the basis for the video that you did watch. Dr. Gawande, the author, talks about end of life practices in it, of course, but he also discusses situations like in Case 5. He observes that we often trade freedom for safety with our elderly. It makes family feel better, but it can be devastating for the elderly person. Alternatively, he advocates for creative solutions that allow folks to stay in their own homes or in facilities which allow a lot of freedom (i.e., to have pets, to sleep and eat on their own schedules, to be able to lock their own doors). It really struck me that as a society we don't have many good "solutions" for the "problem" of growing old and frail.
After I read this case “number five” I felt a little upset to think that someone would actually follow orders to sedate a patient because of his choice. I understand that the family was trying to protect their loved one from harm but they are doing more harm by trying to make his decisions for him. If Ronald X wants to go home in live his life with knowledge that he is at risk for injury he has the right to do so. Neither family nor doctor should stop him. As nurse’s we are reasonable to assist with the patients’ rights and let them make an informed decision based on all health information that has honestly been provided. Sedation should only be used as a last restore to stop a patient from harming themselves in this case I feel it was used wrong and could cause the patient to have mistrust in the health care workers and his family.
I agree with you that the nurse should not have sedated the patient to subdue him from leaving. I think even if she were following Dr.'s orders, she should be an advocate for the patient. Nurses do a good job de-escalating situations like that and she probably could have convinced him to stay until they could all have a conversation. I think with a little more talking and explaining their fears, they could probably convince him to move into a home where he can be assisted more, but doesn't sound like he needs a nursing home yet.
I believe Ronald X's family and health care providers are not justified to leave him out of the decision making process. With his intermittent state of confusion, it is fair to say he can not be truly autonomous in his decisions due to internal constraints, but he is well enough to have some input in this decision. I'm not sure why the nurse sedated him because he wanted to be discharged. The nurse acted against the patients wishes and coerced him into staying by chemical restraint. She acted on the principle of paternalism, interfering with the patients autonomy in an effort to prevent him from leaving and doing harm to himself. This was arguably not the right thing to do. The patient did not demonstrate combativeness or violence and was in his right frame of mind at the time. I believe they all should communicate better with Ronald, and not just jump straight to a nursing home stripping him away from all his independence. A meeting with the health care team and social services would help identify his needs and determine better options for him . Assisted living or senior apartments would be an appropriate option, or moving in with one of his children if possible. This limitation on Ronald X's liberty is somewhat obligatory. With his intermittent episodes of confusion, he lacks appropriate judgement at times and can not be completely autonomous. However, the family can honor his wishes the best they can so he does not feel helpless and let him make decisions for himself when appropriate. The family's priority is to make sure he is safe and accounted for, which means they have to step in and take the reigns in this situation.
Carla, I agree the process was handled poorly. The patient did not show any behaviors that warranted chemical restraints. The entire healthcare team should have collaborated with patient and family and came to a better alternative. Great post!
Excellent job, all of you, on analyzing the situation using the lens of autonomy. I suspect this is a situation where you would have given the same answer before this course, but now you have more specific language to talk with more nuance and depth about Autonomy & Paternalism.
I feel like the patients children and the healthcare system are making an unjustified leap in deciding the patients living arrangements without taking into consideration of his desires. It is like they are deciding its my way or no way. This patient is having periods of confusion and it may lead the family and health care professionals to believe he can not cognitively make his own decisions. This makes patient get upset and then it is viewed as agitation so he is then given medication to calm him down which to me can be viewed as "chemical sedation". This can be viewed as paternalistic limitation, all parties involved think they are doing what is right for the patient but they are not taking into consideration the patients wants.
I agree Donna. I believe medication used in this way is wrong on many levels. If the staff could prove in a court of law the patient is incompetent, then that could lead the family to legal proceedings for the safety and well being of the patient.
I feel that the family and the healthcare professionals are going about the disposition of Ronald X in the wrong way. Even though he has periods of confusion, he is still of sound mind the majority of the time and should be able to make decisions for himself. To sedate him is a form of chemical restraint and is against the patient's rights. A better approach would be to make other suggestions regarding disposition after discharge...live with family, have family take turns staying with patient, assisted living facility, or private duty help. Even though the family and healthcare workers may believe they are doing so in the best interest of the patient, I believe their actions are morally reprehensible. They are taking away all of the patients rights.
I agree Sarah. They should at least try other solutions before forcing him to move to a nursing home. They seem to be treating him as if he was a burden to them. Maybe having adult protective services put their two cents in might help with other options.
I agree Sarah. They should at least try other solutions before forcing him to move to a nursing home. They seem to be treating him as if he was a burden to them. Maybe having adult protective services put their two cents in might help with other options.
The healthcare professionals administering medication without the patients consent was unethical and illegal.I believe it could be considered assault and battery. The patient may have intermittent confusion, but he was not in that state when he admitted he had a problem and the risks he faced. It is morally reprehensible.
I believe that the whole situation is unethical and illegal as well. I would never what any of my family members to be treated this way for any reason.
I agree. I think there are enough options that could be offered to the patient such as assisted living,a retirement apartment, a cell phone that he could wear around his neck that allows for tracking location, or neighbors checking on him daily with in person visits or phone calls. Hopefully he and his family could find some middle ground to solve this problem, but if not it is still his right to refuse until the proper legal steps have been taken.
I can appreciate the concerns of Ronald X’s children. The risks to a 71 year old wandering around the city, especially when confused, are real and possible significant. The case states he is aware of the risks and willing to accept those risks in trade for any independence he can enjoy. I think the way the health care workers who made the decision to basically chemically restrain the patient against his will is not only morally reprehensible, but abusive and illegal. This situation is one where I think there is great opportunity for education. The children could have been educated on services available to Ronald X to keep him safe in his home during periods of confusion. I would have to assume there was an order for sedation given by Ronald X’s physician for the sedation, and that social workers in charge or assisting with his discharge were aware of his wishes. The entire system failed Ronald X. It sounds as if he was cooperating to the point of acknowledging his periods of confusion and as I stated before well aware of the risk vs benefit. Periodic confusion where a patient may or may not wander out is in no way ideal, neither is a patient who is non-compliant with medications or follow up appointments. Or a patient who refuses to attempt to control blood sugars, or a patient who has had syncope or seizures and continues to drive.
I like the point that you made Monica. It is not an ideal situation with periods of confusion, but it really is not that different from the poor decisions that we see other patients make regarding their health and wellbeing.
I feel sedation should only be used if a patient is really at risk for hurting themselves or others and it should never be done at a regular hospital. This should only be done at a behavior health unit or in the ICU with patients that are on vents. This should not be due for a person to assist him going alone with their discharge plan. Social work should sit down with the patient and family to come up with a better plan that everybody can agree on. I have periods of confusion if my blood sugar goes low, so should I be placed in a nursing home?
I agree. I think the hospital is "treating" the immediate symptoms, not addressing the long term goal of the patients well being and safety. As for your personal example, I understand your question. If I awaken in the middle of the night, I am confused, am I considered mentally ill or incompetent? . I know your situation is different because your confusion stems from a physiological diagnosis but would I be consider mentally ill because I wake up confused in the middle of the night? I think the practice of virtue would benefit this scenario.
I believe it is illegal to hold someone against his will (restrain) where no crime has been committed and the person is alert and oriented and is mentally stable. I understand the family's concern for their father but committing him to a nursing home is not the answer. There are a few options, like moving in with family or having a caretaker. Maybe there is a pattern to his confusion and help can be given when it is needed based on this pattern. I would definitely include him in the decision making process this allows him to maintain his autonomy. Also the use of sedation to basically restrain him is also illegal, let alone immoral. I'm not sure what the solution would be to help with the situation but it is definitely not a nursing home.
The healthcare workers and Ronald's children are acting completely unjustified. There are many options on how he could return home safely. Medications should never be used as a way t have someone comply with something that they have already refused while oriented. This is morally reprehensible
The healthcare professionals were completely unjustified when they sedated a pt to comply to a nursing home admission. They are restraining this pt against his will for reasons that they believe are correct. I also believe they have not thought ahead with this plan of action. When Ronald is admitted to the nursing home he will legally be able to sign himself out unless restrained there by a court order. Also what will his feelings be toward his family after this occurs. I understand that they feel it is unsafe for him to be alone but he has the right to decline care unless he is deemed fully unfit to care for himself. It is his right to be in the home of his choice until this is completed.
It was never mentioned that Ronald had been placed on a 72 hr hold. If this did not occur they are holding him against his will and can be prosecuted criminally for this. I find this to be morally reprehensible.
The healthcare professionals are unjustified in sedating Ronald. This paternalistic limitation is reprehensible. Unless Ronald is deemed incompetent to make decisions by a psychiatrist, they are making an unjustified leap regarding his competence. While it is a leap to go to the point of nursing home placement, it does seem like the time to begin considering other alternatives, means of assistance, or monitoring for Ronald. For example, having someone stay with Ronald or having him move in with family, relocation to a senior apartment setting where there are staff who would recognize if Ronald was showing signs of confusion, or obtaining services through life alert with GPS tracking ability. The healthcare providers are obliged to assist the family in identifying a safe discharge plan.
I feel like his children and the health-care professionals are making an unjustified leap in regards to his long-term care. First of all, they should not be sedating him in forms of a restraint because of his behavior. Second, he may have intermittent confusion, however he must be deemed legally incompetent in his decision making in order for his family or health-care professionals to make him go to the nursing home. I do not feel it's morally permissible to make him go to the nursing home, however they do need to make sure he has a safe discharge. They need to consider alternative plans other than long-term care that he is agreeable to.
ReplyDeleteI agree. They need to offer him possible options other than nursing home. The care coordinator or social worker would be a great asset to help assist him in his discharge planning.
DeleteI think the hospital is wrong for sedating Ronald to make him compliant with their plan. I do think he needs a safe discharge plan. I case study doesn't really go into how often he has these confused periods or how long they last. There are other options for him. Why didn't they suggest senior housing or assisted living. A place like that Ronald would be able to maintain his independence while someone would be able to see his comings and goings. Sounds to me like Ronald would pass a mini mental so therefore he should be able to be involved in the decisions made regarding his care.
ReplyDeleteSometimes I think it is hard for people to look at their aging parents who want to continue to make decisions about their life and they want to remain as independent as possible even when it may not always be in the aging parents best interest. We often avoid having these discussions prior to or in the event that something could happen. It is not a discussion that people like to have but I think is often necessary.
DeleteSedation is a form of restraint that is one of the last resorts to make the patient safe to self and others. If the patient is not a harm to self or others, sedation should not be an option of treatment. The facility is not following professional standards of practice that are defined from professional organizations such as JACHO. Ronald X or his family could actually pursue to prosecute the facility for not abiding by the professional standards of practice guidelines especially if the patient is deemed mentally compentant. The health care professionals should not be obligated to follow the paternal model as their primary bases of care. The health care providers in this case are not the parent of the patient however; they should advocate for him, discuss a mutual goal and grant his wishes. If the health care professionals are apprehensive about his plan, the health care professionals should report their concerns to adult protective services to investigate. This would demonstrate the willingness of the health care professionals to respect the patients’ rights, provide alternative solutions and what I believe is doing what is morally correct.
ReplyDeleteWe all know that there are alot of options to keep patients out of nursing homes and in their own homes now days;. I think the family would have no problem with the hospital sedating him because they are going with what they want to happen to the patient.
DeleteI do not agree with the decisions of the healthcare workers sedating Ronald X to be able to go through with their plan of sending him to a nursing home. I understand the concerns that the family may have but sedating a patient for these reasons is very immoral and wrong. Ronald X appears to be only intermittently confused so placing him in a facility without his consent and against his wishes is not right. In this situation there needs to be other plans to keep Ronald safe while at home.
ReplyDeleteI agree that placing Ronald in a facility is not right. Also something to consider is the fact that along as Ronald is alert and oriented he would have the legal right to sign himself out of the nursing home should he be placed there. Then what has the family and/or hospital gained in this case?
DeleteI also agree putting Ronald in a nursing facility is not the right thing to do. He is still able to make choices and no one should be able to stop his legal right to do so.
DeleteChemical restraints? Never the answer to making the right choice. Could the confusion be caused from medication or an infection? Were these things even taking into consideration? I think other possible causes of the confusion should have been explored.
DeleteI am not in agreement with the hospital to sedate Ronald X so he will be compliant to be discharged to a nursing home. I can understand the family's concern for his safety and well being, but that is ethically and morally wrong. I do not understand how his children would allow this to happen, and knowing that he does not want to go to a nursing home, want to send him there anyway. They need guidance from social work to accommodate the family as a whole. They need to be made aware of other facilities such as assisted living or adult day care so he can be attended to, if the family have work obligations.
ReplyDeleteI agree Tricia, sounds like social work wasn't every involved in discharge planning. There are so many options available they should have been able to come up with one that could have pleased everyone with a little compromise.
DeleteLike most of the other posts I believe that it is also wrong to sedate the patient. Sedation is a form of restraint that should be used only as a last resort to keep the patient from harming himself or someone else. I feel like the family or health care professionals are not listenting to what the patient wants. If I were the patients nurse i would have social services come in and help the patient and family make the right decisions. There are many options avaliable that wouldn't require the patient going to a nursing home.I would reject the patenalism view on this case because even though they are trying to do the patient good and keep him safe they are taking away the patients autonomy.
ReplyDeleteSherry, good analysis using the lens of Paternalism.
DeleteI think getting social service or adult protective service is a great idea. They can assess the patients needs, provide resources and determine what is needed for the patient.
DeleteI agree. Social service or adult protective services should be contacted in a situation like this. Forcing him to go to a nursing home is wrong. And if the family is pushing for that APS needs to be involved.
DeleteSedating a patient to ascertain compliance is morally wrong. While I understand the point of the family in their fears for Ronald's safety, they have not exhausted all possibilities for this patient , and infringing on his rights to decide for himself is morally reprehensible. They could consider bringing a part-time caregiver to his home, local churches sometimes have people willing to come sit with the elderly, community resources often provide adult day care programs, and their are most likely assisted living and senior housing programs they could look in to. Taking away the autonomy of someone who still has the capability to make his own informed decisions is not the way to approach Ronald's situation.
ReplyDeleteThis comment has been removed by the author.
DeleteI agree sedating Ronald was morally wrong. I like your ideal of bringing in a part- time care giver. Using an outside resouce can make all the difference.
DeleteI see lots of creative problem-solving in these posts. I remember a hospice chaplain once saying that she would ask family if they could support a decision even if they didn't agree with the particular decision.
DeleteYou didn't read it, but there is a book called Being Mortal, which is the basis for the video that you did watch. Dr. Gawande, the author, talks about end of life practices in it, of course, but he also discusses situations like in Case 5. He observes that we often trade freedom for safety with our elderly. It makes family feel better, but it can be devastating for the elderly person. Alternatively, he advocates for creative solutions that allow folks to stay in their own homes or in facilities which allow a lot of freedom (i.e., to have pets, to sleep and eat on their own schedules, to be able to lock their own doors). It really struck me that as a society we don't have many good "solutions" for the "problem" of growing old and frail.
After I read this case “number five” I felt a little upset to think that someone would actually follow orders to sedate a patient because of his choice. I understand that the family was trying to protect their loved one from harm but they are doing more harm by trying to make his decisions for him. If Ronald X wants to go home in live his life with knowledge that he is at risk for injury he has the right to do so. Neither family nor doctor should stop him. As nurse’s we are reasonable to assist with the patients’ rights and let them make an informed decision based on all health information that has honestly been provided. Sedation should only be used as a last restore to stop a patient from harming themselves in this case I feel it was used wrong and could cause the patient to have mistrust in the health care workers and his family.
ReplyDeleteI agree with you that the nurse should not have sedated the patient to subdue him from leaving. I think even if she were following Dr.'s orders, she should be an advocate for the patient. Nurses do a good job de-escalating situations like that and she probably could have convinced him to stay until they could all have a conversation. I think with a little more talking and explaining their fears, they could probably convince him to move into a home where he can be assisted more, but doesn't sound like he needs a nursing home yet.
DeleteThis comment has been removed by a blog administrator.
DeleteI believe Ronald X's family and health care providers are not justified to leave him out of the decision making process. With his intermittent state of confusion, it is fair to say he can not be truly autonomous in his decisions due to internal constraints, but he is well enough to have some input in this decision. I'm not sure why the nurse sedated him because he wanted to be discharged. The nurse acted against the patients wishes and coerced him into staying by chemical restraint. She acted on the principle of paternalism, interfering with the patients autonomy in an effort to prevent him from leaving and doing harm to himself. This was arguably not the right thing to do. The patient did not demonstrate combativeness or violence and was in his right frame of mind at the time. I believe they all should communicate better with Ronald, and not just jump straight to a nursing home stripping him away from all his independence. A meeting with the health care team and social services would help identify his needs and determine better options for him . Assisted living or senior apartments would be an appropriate option, or moving in with one of his children if possible. This limitation on Ronald X's liberty is somewhat obligatory. With his intermittent episodes of confusion, he lacks appropriate judgement at times and can not be completely autonomous. However, the family can honor his wishes the best they can so he does not feel helpless and let him make decisions for himself when appropriate. The family's priority is to make sure he is safe and accounted for, which means they have to step in and take the reigns in this situation.
ReplyDeleteCarla,
DeleteI agree the process was handled poorly. The patient did not show any behaviors that warranted chemical restraints. The entire healthcare team should have collaborated with patient and family and came to a better alternative.
Great post!
Excellent job, all of you, on analyzing the situation using the lens of autonomy. I suspect this is a situation where you would have given the same answer before this course, but now you have more specific language to talk with more nuance and depth about Autonomy & Paternalism.
ReplyDeleteI feel like the patients children and the healthcare system are making an unjustified leap in deciding the patients living arrangements without taking into consideration of his desires. It is like they are deciding its my way or no way. This patient is having periods of confusion and it may lead the family and health care professionals to believe he can not cognitively make his own decisions. This makes patient get upset and then it is viewed as agitation so he is then given medication to calm him down which to me can be viewed as "chemical sedation".
ReplyDeleteThis can be viewed as paternalistic limitation, all parties involved think they are doing what is right for the patient but they are not taking into consideration the patients wants.
I agree Donna. I believe medication used in this way is wrong on many levels. If the staff could prove in a court of law the patient is incompetent, then that could lead the family to legal proceedings for the safety and well being of the patient.
DeleteI feel that the family and the healthcare professionals are going about the disposition of Ronald X in the wrong way. Even though he has periods of confusion, he is still of sound mind the majority of the time and should be able to make decisions for himself. To sedate him is a form of chemical restraint and is against the patient's rights. A better approach would be to make other suggestions regarding disposition after discharge...live with family, have family take turns staying with patient, assisted living facility, or private duty help. Even though the family and healthcare workers may believe they are doing so in the best interest of the patient, I believe their actions are morally reprehensible. They are taking away all of the patients rights.
ReplyDeleteI agree Sarah. They should at least try other solutions before forcing him to move to a nursing home. They seem to be treating him as if he was a burden to them. Maybe having adult protective services put their two cents in might help with other options.
DeleteI agree Sarah. They should at least try other solutions before forcing him to move to a nursing home. They seem to be treating him as if he was a burden to them. Maybe having adult protective services put their two cents in might help with other options.
DeleteThe healthcare professionals administering medication without the patients consent was unethical and illegal.I believe it could be considered assault and battery. The patient may have intermittent confusion, but he was not in that state when he admitted he had a problem and the risks he faced. It is morally reprehensible.
ReplyDeleteI believe that the whole situation is unethical and illegal as well. I would never what any of my family members to be treated this way for any reason.
DeleteI agree. I think there are enough options that could be offered to the patient such as assisted living,a retirement apartment, a cell phone that he could wear around his neck that allows for tracking location, or neighbors checking on him daily with in person visits or phone calls. Hopefully he and his family could find some middle ground to solve this problem, but if not it is still his right to refuse until the proper legal steps have been taken.
DeleteI can appreciate the concerns of Ronald X’s children. The risks to a 71 year old wandering around the city, especially when confused, are real and possible significant. The case states he is aware of the risks and willing to accept those risks in trade for any independence he can enjoy. I think the way the health care workers who made the decision to basically chemically restrain the patient against his will is not only morally reprehensible, but abusive and illegal. This situation is one where I think there is great opportunity for education. The children could have been educated on services available to Ronald X to keep him safe in his home during periods of confusion. I would have to assume there was an order for sedation given by Ronald X’s physician for the sedation, and that social workers in charge or assisting with his discharge were aware of his wishes. The entire system failed Ronald X.
ReplyDeleteIt sounds as if he was cooperating to the point of acknowledging his periods of confusion and as I stated before well aware of the risk vs benefit. Periodic confusion where a patient may or may not wander out is in no way ideal, neither is a patient who is non-compliant with medications or follow up appointments. Or a patient who refuses to attempt to control blood sugars, or a patient who has had syncope or seizures and continues to drive.
I like the point that you made Monica. It is not an ideal situation with periods of confusion, but it really is not that different from the poor decisions that we see other patients make regarding their health and wellbeing.
DeleteI feel sedation should only be used if a patient is really at risk for hurting themselves or others and it should never be done at a regular hospital. This should only be done at a behavior health unit or in the ICU with patients that are on vents. This should not be due for a person to assist him going alone with their discharge plan. Social work should sit down with the patient and family to come up with a better plan that everybody can agree on. I have periods of confusion if my blood sugar goes low, so should I be placed in a nursing home?
ReplyDeleteThis comment has been removed by the author.
DeleteI agree. I think the hospital is "treating" the immediate symptoms, not addressing the long term goal of the patients well being and safety. As for your personal example, I understand your question. If I awaken in the middle of the night, I am confused, am I considered mentally ill or incompetent? . I know your situation is different because your confusion stems from a physiological diagnosis but would I be consider mentally ill because I wake up confused in the middle of the night? I think the practice of virtue would benefit this scenario.
DeleteGood example Elizabeth. I think if his family would put themselves in Ronald's position they might change their minds.
DeleteGood example Elizabeth. I think if his family would put themselves in Ronald's position they might change their minds.
DeleteI believe it is illegal to hold someone against his will (restrain) where no crime has been committed and the person is alert and oriented and is mentally stable. I understand the family's concern for their father but committing him to a nursing home is not the answer. There are a few options, like moving in with family or having a caretaker. Maybe there is a pattern to his confusion and help can be given when it is needed based on this pattern. I would definitely include him in the decision making process this allows him to maintain his autonomy. Also the use of sedation to basically restrain him is also illegal, let alone immoral. I'm not sure what the solution would be to help with the situation but it is definitely not a nursing home.
ReplyDeleteThe healthcare workers and Ronald's children are acting completely unjustified. There are many options on how he could return home safely. Medications should never be used as a way t have someone comply with something that they have already refused while oriented. This is morally reprehensible
ReplyDeleteThe healthcare professionals were completely unjustified when they sedated a pt to comply to a nursing home admission. They are restraining this pt against his will for reasons that they believe are correct. I also believe they have not thought ahead with this plan of action. When Ronald is admitted to the nursing home he will legally be able to sign himself out unless restrained there by a court order. Also what will his feelings be toward his family after this occurs. I understand that they feel it is unsafe for him to be alone but he has the right to decline care unless he is deemed fully unfit to care for himself. It is his right to be in the home of his choice until this is completed.
ReplyDeleteIt was never mentioned that Ronald had been placed on a 72 hr hold. If this did not occur they are holding him against his will and can be prosecuted criminally for this. I find this to be morally reprehensible.
The healthcare professionals are unjustified in sedating Ronald. This paternalistic limitation is reprehensible. Unless Ronald is deemed incompetent to make decisions by a psychiatrist, they are making an unjustified leap regarding his competence. While it is a leap to go to the point of nursing home placement, it does seem like the time to begin considering other alternatives, means of assistance, or monitoring for Ronald. For example, having someone stay with Ronald or having him move in with family, relocation to a senior apartment setting where there are staff who would recognize if Ronald was showing signs of confusion, or obtaining services through life alert with GPS tracking ability. The healthcare providers are obliged to assist the family in identifying a safe discharge plan.
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