A Legal And Ethical Dilemma - Free Essay Example

Sample details Pages: 5 Words: 1648 Downloads: 8 Date added: 2019/05/18 Category Society Essay Level High school Tags: Ethical Dilemma Essay Did you like this example? Shady Brook skilled nursing facility is facing a legal and ethical dilemma with the care of their patient Mary Evelyn Greene. Mrs. Greene is 89 years old and suffers from the onset of mild dementia as well as other declining health issues related to aging. Don’t waste time! Our writers will create an original "A Legal And Ethical Dilemma" essay for you Create order Although she became depressed over losing her independence and home upon being admitted to this facility, she seems to be pleased with her overall stay here up until her son, David, visits her. David acts as the power of attorney for his mother and deals with her personal affairs. Caring for his mother has become a major responsibility and quite difficult to deal with on his own. As of late, tending to his mother has begun to interfere with his work life. The nursing staff have become aware of his inimical attitude towards his mother and his thinning patience when visiting. Theyve documented that she seems happier in his absence and agitated in his presence. Mrs. Greene has become too weak to eat on her own and often leaves much of her food on the tray. A CNA that she has grown fond of, Susan Brown, steps into sit with her and feed her when she is able to. Even though her desire to eat has declined and she has gradually lost her appetite, Mrs. Greene has never expressed to the medical staff at Shady Brook that she would like her food to be withheld or that she wished to die. In fact, she seems to still enjoy the smell of certain foods even when she has no appetite, and also responds positively to volunteers who carry out activities at Shady Brook. Therefore, her sons request to respect his mothers wishes of allowing her to die a quick death by not eating, came to the nursing staff as a surprise. Mrs. Greene has not exhibited any suicidal behaviors or expressed suicidal thoughts, which is why the nursing home administrator, Betty Wright, is concerned with whether she should trust his decision and motives. This becomes a legal and ethical dilemma as the ethics committee must examine the patients rights, the states laws related to assisted suicide, the patients mental capacity, their best interest and stay within the legal realm of their facilitys operations. With the threat of a lawsuit coming from Mrs. Greenes son, the ethics committee must make a decision that not only reflects the best interest of Mrs. Greene but also protects their organization legally. Mrs. Greenes rapidly declining health and weight loss should have alerted the nursing staff that there was a need for reevaluation of her plan of care. A weight loss of more than 5 pounds a week should have triggered the immediate attention of her healthcare providers. It is the job of skilled nursing facilities to ensure that the quality of life for each client is maximized and to prevent their decline in ability to perform activities of daily living. While it was appropriate to monitor and document her food intake and reactions to certain foods, it is ineffective to record data without seeking ways to improve the issue. Once it was realized that Mrs. Greene no longer possessed the ability to feed herself, someone should have been assigned the task of feeding her or her family/power of attorney should have been notified that the facility was unable to provide this service for her care so that they could assess other options. Even if it meant that the sitter hired by David scheduled her hours around feeding times to assist. There are a few legal dilemmas for Shady Brook in this case. To start, Mrs. Greenes son, who is also her power of attorney, is requesting that the facility withhold food from his mother. However, doing so would be illegal as it is equivalent to assisting in murder. By law and buy contract the nursing home is required to provide Mrs. Greene with care that aligns with best care practices and avoid negligence in duty to their client. It is also difficult to determine her legitimate wishes as she suffers from dementia induced memory impairment. Therefore, her wishes/decisions for her own care could change from moment to moment. This makes it illegal to pursue the wishes that her son claims she had as we are unaware of what her mental state may have been, especially due to the agitated state that David evokes from her. On these legal basis, not even the power of attorney is able to instruct the facility to incriminate themselves. A large portion of the ethical dilemma for Shady Brook in this case lies in the sons wish to enable the death of a relatively healthy person. While his mother may not be in the best health condition, she is far from being in a vegetative state and is still full of life. The only time that the nursing staff has experienced her in an agitated state is during and after visits with her son. Ethically, the facility feels the need to alleviate any suffering that their client feels, even if she wishes to die, which in this case they are unsure of due to her dementia. They do not wish to play along and assist Mrs. Greene in a quick death and are unsure of the motives surrounding his threats of a lawsuit. They must also be careful not to allow this threat to prevent them from doing what is right. This situation has progressed beyond the point of suggesting that Mrs. Greene be moved to a different facility because they realize that this is not in her best interest and would not aid her in anyw ay. Lawfully, the patient does not have a right to die and therefore David does not have a case. Because Mrs. Greene is not in a vegetative state, withholding proper nutrition and encouraging death would be illegal. The ethics committee should continue to serve Mrs. Greene meals and provide a staff member to feed her. The previously documented reactions that she had to certain meals should be assessed to see which ones she reacted positively to. These meals should be the ones that are prepared for her to eat. Because Mrs. Greene has already loss a large amount of her body weight due to malnutrition, the ethics committee should also consider tube feedings to ensure that she is getting the proper amounts of nutrients daily and to prevent/reverse dehydration and malnutrition, especially if she has lost her appetite or has no desire to eat. It May even become necessary to solicit a nutritionist to be heavily involved in Mrs. Greenes plan of care. Many dementia patients suffer from dysphagia. If the foods are difficult for Mrs. Greene to swallow, then the nutritionist may be able to recommend foods that are easier for her to eat. They may also be able to suggest foods that have high nutritional value and aide in treating depression holistically. By serving Mrs. Greene foods that she enjoys the smell of, it may increase her desire to eat even if she lacks an appetite. In doing so, Shady Brook would be fulfilling their legal obligation to care for their patient by making provisions to provide personalized plans of care. Mrs. Greene would also benefit by being served foods that bring her joy and increase her desire to indulge. This has the potential to boost her mood as well as her weight. Both consequences work in her favor. On the other hand, providing her with a tube feeding would protect Shady Brook from negligence but increases liabilities as tube feedings have much more room for error. Mrs. Greene must also be assessed to ensure that her body will be able to properly process the feedings and use the nutrients. If not, the supplement will do more harm than good as it sits in her stomach. If she is eligible for such feedings, Mrs. Greene may welcome the idea. It would prevent her from having to deal with the frustrations associated with meal and feeding times. It would also improve her nutritional health state. By involving a nutritionist in Mrs. Greenes plan of care Shady Brook is ensuring that she receives the best nutrition plan possible for her individual condition. This protects their organization and benefits the overall well-being of their client, Mrs. Greene. Essentially, if it is Mrs. Greenes wish to die by not eating then she can. Although Shady Brooks is required to serve her a meal, she has the right to refuse to eat it, but the meal must be served regardless. She also has the right to refuse feeding assistance. These instances of refusal should be documented in the event that negligence is suspected. Because of Mrs. Greenes mental state her power of attorney, David, may need to be consulted as well. I would recommend that the ethics committee continue to serve Mrs. Greene meals, preferably those in which she has reacted positively to previously. I would also recommend that they assign someone to sit with her and assist during feedings. When available, this person should be Susan Brown since she has taken such a liking to her. Her appetite seems to improve when Susan assists her as well. This relationship and attention to detail in her care has potential to improve her overall condition. The additional attention could aid in her depression as well, as she seems to enjoy it and thrive from it. The ethics committee should take into consideration Bettys comment that David needs the money to educate his children. Being that he seems to be the sole heir to his parents estate it appears suspicious that he is so adamant about allowing her death. Although he has presented it as his mothers own wishes, it very well could be his own, especially considering that no nursing staff previously reported suicidal behaviors or statements from Mrs. Greene.

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The nineteenth century in the US Free Essays

The nineteenth century in the US had an unmistakable theme, immigration. Over 20 million immigrants, mostly European, came to the United States between 1820 and 1900. They came for a variety of reasons. We will write a custom essay sample on The nineteenth century in the US or any similar topic only for you Order Now Most came because the economies of many European countries were in crisis and workers had a very hard time finding work. As well, some fled religious and cultural persecution. Most of them decided to come to the US because of the opportunities they had heard abounded in the US. One immigrant put it well when he said, â€Å"We are in such bad shape and in need of so much that there is nothing left for us here, we must go. † Once they arrived in the US, the immigrants were seen as second class citizens by the vast majority of US citizens. As one American put it, â€Å"I can’t understand those scum, those immigrants, for they talk differently and do things differently than I do. † The flood tide of Europeans also overwhelmed the limited charitable services available at the time. One historian referred to the settlement house movement as, â€Å"effective as bailing out the ocean with a teaspoon. Immigrants emigrated to America for the opportunity to improve themselves and found horrible working and living conditions that were a large price, although it was one they were willing to pay. Immigrants came to the US because of political persecution and economic hardships at home. Some European countries persecuted certain ethnic groups for no apparent reason. For example, both Yugoslavia and France blamed Jews for their economic problems. As the French Secretary of the Treasury put it, â€Å"Those Evil Jews who befoul our towns shall not work here, for they are second. Christians shall get the right. † Jews would get beaten by the police and as a result sought political asylum in the â€Å"land of the free†, the United States. It was also extremely difficult for many to get jobs in Europe where 50% of the workers were unemployed in some countries. The main exception was England which thrived on industry as the US did. Workers were encouraged to go to the US because of pamphlets that gave such promises as â€Å"Good work, a free life, a good life for all. † The demand of factory workers was constantly growing, and immigrants decided to take their chance. As one immigrant said, â€Å"We have nothing to lose, for we have nothing. The US is our greatest and only chance. † Immigrants came to the US expecting a higher standard of living but were forced into poor living and working conditions. The vast majority of immigrants, who lived in cities, lived in tenements. These were apartment buildings that were shabbily constructed and contained extremely small apartments. Twenty four to thirty two families were packed inside these six to eight storey structures, often referred to as dumbbell buildings due to the air shaft between the buildings that made them look like dumbbells from above. The residents were highly susceptible to disease, and life expectancy was significantly lower, by about 10 years, in these areas. Up to 4,000 people lived on some city blocks. Families had one, maybe two, small rooms. They had no privacy as the walls were thin as well. As one immigrant put it, â€Å"I can’t even talk without my entire building knowing what I said, the walls are so thin. † Bathrooms were also usually outside, although around the turn of the century, some began to appear inside. Tenements were also susceptible to fires. Due to the required air shaft between buildings, the air got trapped which caused more fires. As the material that tenements were made of was very susceptible to fire, widespread fires were common. As one immigrant described it, â€Å"I watched it and as the flames struck it, the entire block seemed to go up in a flash. It was horrible. † Working conditions for the immigrants were also horrific. The immigrants generally did two kinds of work. The first were the jobs Americans wouldn†t do and the second were the unskilled jobs that almost any person, American or immigrant, could do. Immigrants were also willing to be paid less money for the same work. Immigrants were often used as strike breakers because many of them didn†t understand the concept of strikes since it wasn†t part of their culture. The immigrants saw these jobs as ones that had been abandoned and so they took them, provoking anger in Americans for â€Å"job stealing†. As Guillaume Fouchon said,†We do not strike because it challenges our honor. As well, in the old country, there were so few jobs and so many workers. † Also, immigrants misunderstood the process of striking because it was hard to organize people who spoke different languages. Immigrants also had very little in the way of political power. This was not much of a problem, however, for as one immigrant said, â€Å"I just want to succeed, and then I’ll worry about how much political power I have. † With the exception of some groups like the Irish, the immigrants had no political power at first. However, near the turn of the century, immigrant votes became a factor as they represented 15% of the voting public in New York alone. This caused the immigrants to gain increased political power through the vote. The Chinese were often called the devils of the immigrants. They were different than all the other immigrant groups because they had a different complexion. As a result, they were subject to more prejudice. The Chinese, who mainly lived and worked in California, took many railroad jobs away from the preexisting Americans. This resulted in their being stoned and having their houses burned to the ground. Such actions were supported by both major parties. As a Democratic National Committee spokesman said, â€Å"We must fight to rid the earth of the evil Chinese. † This was significant because even the â€Å"party of the immigrants†, the Democrats, were against the Chinese. Also, most Chinese, unlike most Europeans, wanted to go to the US, earn money and then go back to China. The American public resented the Chinese and labeled them as a second-class race. As a result of all this prejudice, the Chinese were largely banned from immigrating. As Robert Ingersoll said, the Chinese were not allowed to follow the national progression that benefitted earlier immigrants. Immigrants hoped that by coming to America, they could still retain their culture which they were unable to do in large part due to the education system. Immigrants hoped that they could both move up socially to the same level as the Americans as well as keep their identity intact. When they first arrived, immigrants kept their cultural identity intact by creating ethnic neighborhoods such as Little Frances or Little Italies. These were places for people of one ethnic group, or even one town or one province, to retain their cultural values. These were very prominent, with 17 little Italies in Chicago alone. It was essential for these immigrants to have these places to attempt to avoid assimilation. As Italian immigrant Verduccio Marsongeri put it, â€Å"I need my little Italy because the old country is still so important to me. † In this way, the free education given in the US to most children, American or immigrant, was a mixed blessing. While it certainly prepared immigrant children for better jobs due to better education than their parents had had, education also resulted in a loss of cultural identity. Those children who were educated in the US were instilled with American and not old country values as well as English as the primary language. This was in fact an intended consequence of the education expansion, that the immigrant children be assimilated into American culture so as to eliminate the foreign influence on the US. While immigrants certainly didn†t want their children to be assimilated into American culture, they were willing to pay the price if it meant better education. This accounted largely for the 3 fold increase in students from 7 million in 1870 to 22 million in 1920, as well as a rise in participation from 57 to 78 percent. While the doors of primary education were open, the doors of higher education remained largely closed to the immigrant. Immigrants could go to some lower tier private colleges and state universities, but not in general to the big names such as Yale, Harvard or Stanford. Yet, still it was a major improvement for now the immigrants could be educated the same as Americans. In conclusion, the immigrants came to the US in search of opportunity but found harsh conditions. The opportunity and advances the immigrants made in the US came at a large price. Factory workers were not able to move up and were forced to work in horrid conditions for low pay. Many despaired and wanted to move back, but they couldn†t due to lack of money. Many more, however, willingly stayed. The real benefits of American opportunity and culture would be passed down to the succeeding generations. Overall, the immigration from the Europe and Asia to the US was the largest in world history. As Christa Jackstone, historian, said about the affect immigrants had on the US, â€Å"Immigration in the late 19th and early 20th century really made this country because they literally built this country. As the blacks had done in the years before the Civil War, the immigrants were doing the hard work behind the scenes while other people took credit for it. † Although the immigrants themselves paid a large price, they willingly took the first steps that would benefit future generations. How to cite The nineteenth century in the US, Papers