The Case Study of Patient With Late-Stage Alzheimer’s Disease

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Introduction

Nursing is a profession where nurses must deal with various ethical and legal challenges to care for their patients. These difficulties are frequent while caring for a patient with Alzheimer’s disease. The case study of Mrs. Bentley, an 82-year-old female patient with late-stage Alzheimer’s disease, serves as the basis for the discussion in this essay. In this situation, the problem is getting her permission to be spoon-fed. This paper will cover two pertinent questions about this case study and a thorough conclusion.

Discussion

According to Mrs. Bentley’s case study, it was determined that she had late-stage Alzheimer’s illness. In the majority of cases of Alzheimer’s, it has been shown that patients are unable to make decisions on their own and are also unable to communicate their assent verbally. However, if patients can communicate their thoughts or preferences through a reaction, it is safe to conclude that they agree with the activity (Thorogood et al., 2018). Due to miscommunication, obtaining consent may have several legal and ethical concerns. Similar problems were discovered in this case study.

Whether or not the patient gave consent to being spoon-fed is under dispute. The carers interpreted the patient’s conduct in accepting some meals while rejecting others as consent. In addition, the Mental Capacity Act of 2010 outlines specific fundamental legislative guidelines for determining a patient’s competence to make decisions. A person must be presumed to have capacity unless it is proven that he lacks it. A person is not to be viewed as incapable of choosing unless all reasonable efforts to assist him in doing so have been made without success.

These are the first and second principles of this act. Therefore, the healthcare professional interprets the patient’s reaction to eating as permission (Barnett et al., 2019). Additionally, even if a patient has moderate or severe Alzheimer’s disease and has impaired cognition, he or she may be able to make a decision and show some comprehension (Charles et al., 2017). Professionals should carry out suitable evaluation procedures, including understanding, appreciating, communicating a choice, and reasoning. The professional caregiver in this case study utilized his or her expertise to determine that the patient could make food-related decisions. Consequently, after reading the debate, it may be concluded that persons with Alzheimer’s can give some or all permission at this stage. Following the debate, it may thus be concluded that people with Alzheimer’s can give limited or specific permission; however, a proper evaluation is required.

Freedom or self-determination are examples of autonomy, and it encompasses the ability to choose one’s course for their own life and well-being. Patient autonomy guarantees that they are informed, given the opportunity to provide their permission, and that they are of legal age. Everyone has the right to life, liberty, and personal security, as stated in the Charter of Rights and Freedoms (Yeo et al., 2020). In Margot Bentley’s case, it was alleged that her Alzheimer’s condition caused her to lose the ability to agree. She gets fed with a spoon to her lips because she can no longer eat for herself. When she wants to eat, she opens her mouth; when she does not, she closes it.

The most reliable proof of the consent is her approval. Dr. Hilliard, a hospice palliative care physician, and Dr. O’Connor, a capacity assessor for the province, endorsed this (Yeo et al., 2020). Promoting another person’s well-being or welfare is referred to as beneficence. Additionally, it entails averting or eradicating some wrongdoing or, more specifically, intervening to bring about good (Yeo et al., 2020). Asserting that Mrs. Bentley agreed to get food, the staff at Maplewood said that to cease providing her with food and drinks would speed up her starved death, which may be considered neglect. This is against assisted suicide and criminal law (Yeo et al., 2020). Although autonomy is crucial, beneficence and nonmaleficence are in play.

Mrs. Bentley’s autonomy was respected by the Maplewood staff, who gave her food and beverages for her benefit. Family members refused to accept it and responded to this differently. It is not uncommon for patients, families, or healthcare professionals to disagree on ethics. Before the matter is brought before the court, nursing staff should participate in discussions about it with patients’ families and relatives of the patients involved by offering information and sharing their opinions.

Mrs. Bentley considered her health in various situations and concluded that she was more afraid of degrading herself and being treated with indignity than dying. She defines degradation and indignity as a state in which she cannot take care of herself in the most fundamental ways. This includes regular chores like feeding and grooming. At that point, she would be defenseless, and her recovery prospects would be limited to none. I lean toward agreeing with Mrs. Bentley’s viewpoints because life is a journey that is often rather challenging and unpredictable. Since no one knows how long they will live, the only chance most people have is to be in a good physical and mental condition to improve their lives every day.

At the very least, one should be able to comprehend reality as it is and make autonomous judgments. When all that is gone, a person is simply left in the care of others, some of whom could hold different values and views from the person they are caring for (Zirak et al., 2017). The ability to live as one chooses is vital since character and belief are formed throughout a person’s life, provided that their manner of living does not negatively impact others or violate the law. However, it is upsetting to continue in an environment that one would consider demeaning and indecent.

Eight years before being diagnosed with Alzheimer’s, Mrs. Bentley wrote her first declaration of wishes while still mentally competent and able to make decisions about her health. She wrote in the first paper that there is no realistic prospect that the patient will recover from her severe physical or mental condition (Yeo et al., 2020). She commands that the woman will be allowed to die and not be kept alive by heroic or artificial methods (Yeo et al., 2020). This remark, in my opinion, is ambiguous because it uses the terms “artificial methods” and “heroic measures.” Giving someone assistance with beverages and food cannot be considered artificial. The artificial assistance provided to patients includes feeding through a nasogastric tube, providing CPAP or BiPAP, and ventilator support.

If so, Mrs. Bentley’s request can mean she does not want food and drinks delivered artificially, such as through a feeding tube. Additionally, giving drinks and nutrition orally cannot be viewed as valiant. She should be provided clarification and required to be more precise about her intentions rather than referring to “artificial methods” and “heroic measures.” Mrs. Bentley wrote the advance directions in this instance and named her spouse as a healthcare proxy. Advance Directives for Resuscitation and Other Life-Sustaining or Sustaining Measures encourage people to express their desires in advance by designating a proxy decision-maker or a written document (Baker & Marco, 2020). In order to make the advance directive clear, people must be specific about the type of actions they anticipate and do not want to take when they cannot make decisions. This will help reduce conflict over their decisions and ensure they receive the care they desire.

I would make certain a copy of my plan is given to my doctor and my substitute decision-maker. My spouse, children, and I would have discussed my future healthcare preferences. If my spouse were alive when I passed away and was mentally and physically able to make decisions about my medical care, he would act as my replacement decision-maker.

I would only want pain medication and comfort measures if I were towards the end of my life and not expected to live. Any intrusive medical or surgical procedures, such as artificial breathing, dialysis, intravenous fluids, or feeding tubes, would not be something I would desire. I want to pass away at home, surrounded by my loved ones. This plan should be used when I cannot make judgments, such as when I am in a coma or when my disease has compromised my judgment.

Conclusion

Overall, it is clear that appropriate evaluation of the patient’s reaction while considering their best interests is crucial for caring for individuals with Alzheimer’s. A person may benefit greatly from having an advance directive when they cannot speak effectively enough to make decisions about their future. People must be detailed about the types of activities they expect and do not want to take when they cannot make decisions for the advance directive to be understood. This will guarantee that individuals get the treatment they want and lessen disputes over their decisions.

References

Barnett, P., Mackay, E., Matthews, H., Gate, R., Greenwood, H., Ariyo, K., Bhui, K., Halvorsrud, K., Pilling S. & Smith, S. (2019). . The Lancet Psychiatry, 6(4), 305-317. Web.

Charles, L., Parmar, J., Brémault-Phillips, S., Dobbs, B., Sacrey, L., & Sluggett, B. (2017). Physician education on decision-making capacity assessment: Current state and future directions. Canadian Family Physician, 63(1), e21- e30.

Baker, E. F., & Marco, C. A. (2020). . Journal of the American College of Emergency Physicians Open, 1(3), 270-275. Web.

Thorogood, A., Mäki-Petäjä-Leinonen, A., Brodaty, H., Dalpé, G., Gastmans, C., Gauthier, S., Gove, D., Harding, R., Knoppers, B., M., Rossor, M., Bobrow, M., Global Alliance for Genomics and Health & Dementia Task Team. (2018). . Alzheimer’s & Dementia, 14(10), 1334- 1343. Web.

Yeo, M., Moorhouse, A., Khan, P., & Rodney, P. (2020). Concepts and cases in nursing ethics (4th ed.). Broadview Press.

Zirak, M., Ghafourifard, M., & Mamaghani, E. A. (2017). Patient’s dignity and its relationship with contextual variables: A cross-sectional study. Journal of Caring Sciences, 6(1), 49.

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