SWK 6035 Aurora University Week 10 American Medical Association Case Study

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SWK 6035

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Drawing from the NASW Code of Ethics, AMA and lecture material, what are the primary ethical principles you see as present and pertinent in this case? Are there conflicts or concerns regarding ethics? In your estimation, are there any actions that should have been taken to address the patient’s and family’s needs or address any ethical concerns?

Please provide a 3-4-page response.


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SWK 6035 – Fall 2020 CASE STUDY FOR ETHICS PAPER Maddie is a 45-year-old female who presented to the emergency department for evaluation of back pain. As part of the workup for her back pain which has been ongoing for the past 4-6 weeks she had an MRI in the outpatient setting. Due to abnormal findings patient was sent to the emergency department for further workup. She has been having severe right-sided lower back pain with radiation down her right leg. At times she has had some numbness and tingling on the sole of her right foot as well as her 3 smaller toes. MRI revealed the presence of 3 areas in the lumbar sacral area concerning for possible metastatic disease. These areas were causing severe narrowing on the right side L5-S1 neural foraminal area and the epidural component of S1-S2 mass lesion contacts the left descending S1 nerve root and impinges on the left descending S2 nerve root. Based on these findings it was felt that patient would need a tertiary care center. She was admitted to the hospital and started on IV steroids. Her pain was better controlled. Pt was transferred to another hospital for specialized care - namely evaluation by neurosurgery due to fear of paralysis due to tumor involvement to spine. No present brain metastases. Maddie is diagnosed with a cancer of unknown origin. After time and treatment at the second hospital including spinal fusion surgery, Maddie was discharged back home where her husband had worked to modify their home to allow for her to be on the 1st floor with bed, etc. Maddie lives with her husband and 14-year-old son, in a 2-story house, with 8 steps and bilateral railings to entrance. Spouse works full-time for a shipping company and his shifts vary. Her sister also works full-time. Her adult daughter lives outside the home but may be able to assist. Patient stated that she had been able to previously perform personal cares, transfers, and used a wheeled walker to assist with ambulation. Spouse takes care of the majority of the household tasks; however, patient would assist with putting groceries away and assist with laundry and some housekeeping. She had also been able to manage finances and medications. Spouse and others take care of transportation needs. Her support system is her husband, sister, children and good friend. Maddie was soon re-admitted back to the first hospital due to further intractable pain where she was again evaluated by the oncologist who recommended chemotherapy. She had additionally fractured her hip and needed additional surgery. She received radiation from radiation oncology to the tumor in an attempt to shrink her tumor to decrease and impact on spine and ambulation, as well as concurrent chemotherapy. She was on steroids and pain medication during the duration of her in-pt stay. Maddie was unable to walk. She displayed anxiety and depressive symptoms during her stay and was seen by the in-patient psychologist. She experienced blood clots and had triggering anxiety about the need for Hoyer lift use to move her, viewing both as signs of impending doom. Maddie was so triggered by the Hoyer that she indicated having a panic attack. She was often tearful and had alternating moods. At other times she portrayed herself as being strong and accepting of her metastatic cancer diagnosis. The oncologist writes in his notes that patient refuses hospice/comfort care. There are no notes or indication of family meeting looking at long-term plan or discussion of the futility of care, etc. The oncologist is known to push care options for younger patients. She was subsequently discharged to a nursing home. There, she is scheduled to be brought to the out-patient cancer center by stretcher and given IV chemotherapy in a private room due to her invalid status. The family is informed that transport will need to be provided by ambulance to Maddie’s inability to sit in a wheelchair for transport. The nursing home initially states that they will not pay for transport to the out-patient cancer center but later relents and looks at options for authorization with Maddie’s insurance for a particular ambulance vendor. Following her discharge from the hospital, she is scheduled to return to the outpatient cancer center in 5 days to receive a new round of chemotherapy. The nursing home assists in getting an ambulance set up for transport. The day before she is scheduled for treatment the cancer center oncologist’s RN receives a call from nurse at the nursing home indicating concern about Maddie. She states that night nurse did not give Morphine. That morning she slept through breakfast. At 2 pm she was awake, had some water but seemed "a little off." She was asked where she was and Maddie stated a different city and gave the date of four days ahead of the actual date. She stated that she is not eating or drinking. BP 128/83, P82, T97.6. The oncologist is informed and suggests that they either monitor patient for a bit longer and if no improvement send her to ER or send her there now if they are concerned. The nursing home staff is agreeable to plan but note that they will have to send her to a local hospital in the city they are located. The next day (when Maddie is scheduled to receive treatment), cancer center staff are informed that Maddie died at the nursing home the night before. Drawing from the NASW Code of Ethics, AMA and lecture material, what are the primary ethical principles you see as present and pertinent in this case? Are there conflicts or concerns regarding ethics? In your estimation, are there any actions that should have been taken to address the patient’s and family’s needs or address any ethical concerns? Please provide a 3-4-page response. Hospice and Social Work SWK 6035 Fall 2020 Christopher David, MSW, LCSW Week 10 Agenda • • • • Terri Schiavo Looking at Capacity Ethical Issues POAHC Looking at Capacity High risk groups for impairment ❑ Neurodegenerative disease – dementia, Alzheimer’s, etc.​ ❑ Tumor involvement in brain​ ❑ Parkinson Disease​ ❑ Psychiatric Disorders – Schizophrenia, Depression, Substance Abuse​ ❑ Traumatic Brain Injury​ ❑ Hospitalized adults – delirium, rx side effects, etc.​ ❑ End of life / Dying process​ Pertinent terms • Capacity – A person’s ability to make a decision. The ability to utilize information to make an informed choice about treatment. • Competency – Legal term - ability of a defendant to understand and rationally participate in a court process. • Cognition – functions of the brain. • Informed Consent – Competent adults make a voluntary decision following adequate disclosure of relevant information. Mini-Mental State Examination (MMSE) Mini-Mental State Examination (MMSE) Mini-Mental State Examination (MMSE) Maximum Score Score ORIENTATION 5 ( ) What is the (year), (season), (date), (day), (month) 5 ( ) Where are we (state), (county), (town or city), (hospital), (floor) REGISTRATION 3 Cannot itself determine capacity; a patient may have deficits but still have ability to make some decisions. ( ) Name 3 common objects, (e.g. ‘apple’, ‘table’, ‘penny’). Take 1 second to say each. Then ask the patient to repeat all 3 after you have said them. Give 1 point for each correct answer. Then repeat them until he/she learns all 3. Count trials and record. Trials: ATTENTION AND CALCULATION 5 ( ) Spell ‘world’ backwards. The score is the number of letters in the correct order ( D__ L__ R__ O__ W__ ) RECALL 3 ( ) Ask for the 3 objects repeated above. Give 1 point for each correct answer. [Note: recall cannot be tested if all 3 objects were not remembered during registration.] LANGUAGE 2 ( ) Name a ‘pencil’ and ‘watch’ (2 points) 1 ( ) Repeat the following “No, ifs, ands, or buts” (1 point) 3 ( ) Follow a 3-stage command: ‘Take a paper in your right hand, Fold it in half, and Put it on the floor’ (3 points) Read and obey the following: 1 1 1 ( ( ( ) ) ) Score Ranges 24 – 30 18 – 23 10 – 17
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Running Head: ETHICS STUDY

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Ethics Study
Student's Name
Institutional Affiliation
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ETHICS STUDY

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Ethics Study
Both the American Medical Association (AMA) and the National Association of Social
Workers (NASW) Code of Ethics set a guideline in which health and social work professionals
must follow their day-to-day encounters with patients. Also, they give a point of reference in
case a physician or social worker is experiencing confusion or an ethical dilemma. Sometimes,
these conflicts from patient interactions can be inevitable, so the physicians/social workers must
know how to navigate them to reach a satisfactory outcome. It is also imperative to observe and
uphold the AMA and NASW Code of Ethics as it distinguishes the ethical responsibility and
values in which social workers and health professionals are expected to adhere to the
conventional ethical standards.
What are the Primary Ethical Principles You See as Present and Pertinent in this Case?
In Maddie's casework, we can see how her disease progression affected her capacity to
decide with the insurmountable pain she was experiencing; under NAS...

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