Jody Smith: Application of the Moral Model…
Applying Ethical Decision Making Model
"Jody Smith Case Study: Application of Thiroux's Moral Model"
The decision making model that will be applied in this work is the Moral Model (Thiroux 1977) and the case it will be applied to is the Jody Smith case. The reason this model was chosen is because the model lends itself best to a situation, such as Smith's where an impasse has been reached between the patients values and desires and that of family and the health care team. In this case the ethical dilemma is one clearly of informed consent as Smith has been excluded from conversations associated with her prognosis and care and this is contrary to her values and her identity. Without inclusion of this communication standard Smith has very little to go on regarding her prognosis and may be seeing her situation as insurmountable not only because of the lack of information but because she has been excluded as an informed part in the process. It is likely that there may be some resentment on Smith's part regarding this exclusion from informed consent and that her recent rehabilitation from total hip replacement is stark in her memory.
"Jody Smith, a retired nurse with 3 adult children and numerous adult grandchildren, lives alone in a small rural area. Her income is limited. Two months ago, she fell and broke her left hip. After surgery for an artificial hip replacement, she was transferred to a rehabilitation center, where she had a left sided cerebrovascular accident (CVA). She was then readmitted to the acute care facility, where she has received aggressive therapy of the CVA.
Completely paralyzed on her left side, Mrs. Smith has decided that she no longer desires aggressive therapy and frequently asks the staff why she cannot die in peace. "The rehabilitation is so painful and I'll never walk again. What's the use?"
Both the doctors and her family are much more optimistic. The orthopedic surgeon is convinced that she will walk again, and the neurologist believes that she will make a full recovery and be able to return home and care for herself. Both doctors have excluded Mrs. Smith from their conversations, assuring her children that she will be "as good as new" and ignoring her requests to discontinue anticoagulant and rehabilitative therapy.
While not in a life-threatening condition, Mrs. Smith refuses to cooperate with the physical and occupational therapists and to take her medications. She also refuses to perform simple tasks, relying on staff to meet her activities of daily living. (Guido, 2010)
According to the Thiroux Moral Model (1977) the following sections will be applied to the case of Ms. Smith. Ms Smith are dealing with a dilemma concerning the desire to remove herself from any further aggressive treatment and refusing any further treatment.
Thiroux Moral Model Applied
M massage the dilemma IDENTIFY and define issues in the dilemma consider the opinions of the major players patients family members nurses physicians clergy and other interdisciplinary healthcare members as wells as their value systems
The most immediate moral and ethical dilemma associated with the care of Smith is the rational and realistic communication of Smith's prognosis to her through the inclusion of her in discussions regarding her medical care. Given that Smith is a former nurse her reluctance to continue aggressive treatment may in part be supported by the fact that someone just telling her she has a chance is not the same as being informed by her physicians of the advances and developments that make it possible for her to have a full recovery as well as her real condition, in medical terms. Smith needs very much to be included in any and all communications about her care, and not excluded as she has been. Her desire to stop care might or might not be changed by the process of communication but she is the patient, she has her own medical power of attorney and she is likely the most knowledgeable of all parties, excluding the rehab specialists and the doctors, of the specifics of care that may be needed for her prognosis of a full recovery to prevail. The ethical/moral dilemma is therefore seated plainly in the fact that she has been excluded from communications which is contrary to her history as a nurse and contrary to her rights and values as a person. Secondly, pain control management needs to be addressed more aggressively with Smith. There are alternatives to narcotic pain control that might alter her ability to be involved in a painful process of physical therapy but that would allow her greater comfort in attempting rehabilitation.
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