The case presented for analysis with respect to nursing practice and the American Nurses' Association Code of Ethics (2004) is that of Ms. W, a 55-year-old African-American grandmother diagnosed with advanced lung cancer who has been responding well thus far to radiation and chemotherapy treatments. However, recent tests indicate that Ms. W has experienced a 20-pound weight loss along with metastases to the bone. Her oncologist recommended immediate hospitalization for further evaluation, but Ms. W refused, claiming that familial responsibilities (caring for minor grandchildren, an aging and ill mother, and a wheel-bound adult son) prevent her from leaving the family at the present time.
Further. Ms. W appears disengaged with her own medical condition and treatment needs. While she keeps appointments and takes medication as prescribed, she exhibits avoidant behavior with respect to the severity of her condition, the potential for loss if life if further evaluation and treatment do not occur, and a concomitant determination to receive all possible care to avoid being given substandard care. She is clearly experiencing denial and has not developed meaningful relationships with caregivers, with the exception of the RN on the outpatient oncology team providing care to the patient for 2 years.
At issue in this case are several concerns. First, the failure to secure evaluation leading to treatment presents a direct and immediate threat to Ms. W's life. Secondly, her family seems to have little knowledge regarding the nature of her illness and its ramifications with respect to their own situations. Third, Ms. W's denial prevents her from pursuing the kinds of treatment needed to prolong her life or improve her situation; this denial also prevents Ms. W from addressing important personal and familial issues related to her possible death and its effects.
The nurse therefore has several ethical issues which must be confront...