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C‌‍‍‍‌‍‍‌‌‍‍‍‌‍‍‍‍‌‍‍ase: Ethical Management of Patients with Cancer and Mental

by | Sep 23, 2021 | Healthcare and Nursing | 0 comments

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C‌‍‍‍‌‍‍‌‌‍‍‍‌‍‍‍‍‌‍‍ase: Ethical Management of Patients with Cancer and Mental Illness TM, a 56-year-old man with schizophrenia, presented to his primary care physician with intermittent difficulty swallowing. He did not elaborate on exacerbating or alleviating features or associated symptoms. His review of systems was negative. TM lived locally in an adult home. He was unwilling to consistently perform activities of daily living, such as bathing and dressing. The nursing staff of the adult home provided his medications. TM’s younger sister was his next of kin and had health care power of attorney. She attended appointments with him and assisted him in making decisions regarding his health care. Specifically, she aided in explaining clinical information to him in a manner that he seemed to better understand. She would not consent to procedures or therapies to which he was opposed. Physical exam revealed a thin and disheveled man. He was alert and oriented. He had no outward signs of perceptual disturbances such as delusions or hallucinations. The remainder of the exam was unremarkable. A chest radiograph revealed a lung mass. The patient was referred for a CT-guided biopsy of the lesion. Although he was initially reluctant, he ultimately agreed to the procedure after further counseling and discussion, and his sister supported his decision and provided consent. The biopsy confirmed the diagnosis of squamous cell carcino‌‍‍‍‌‍‍‌‌‍‍‍‌‍‍‍‍‌‍‍ma. Further staging did not reveal locally extensive or metastatic disease. Therefore, the cancer was considered to be Stage Ib. He was referred to the surgical oncology service for possible resection of the mass. During the initial surgical consultation, the patient stated that he did not believe he had cancer and would not consent to any surgical procedures. However, during a subsequent visit, the patient acknowledged the diagnosis and stated that he would consider surgery. After lengthy deliberation about the case, the members of the surgical oncology team opted against surgical intervention based on their feeling that the patient did not reliably demonstrate a good understanding of the diagnosis and might therefore have a higher risk of complications postoperatively. They stated that they did not feel it was safe to operate but offered no further explanation. TM completed radiation therapy, and a six-week post-treatment CT scan revealed stable disease, although with possible residual tumor. 1. Utilizing the above case study, explore how you as the provider would practically and ethically create management strategies for this patient. Base your management upon one ethical theory, assigned readings, and the provided PowerPoint presentations. Be sure to include a brief background of the case, issues surrounding the elements of full informed consent, and capacity. Use attached files for discussion on pa‌‍‍‍‌‍‍‌‌‍‍‍‌‍‍‍‍‌‍‍per

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