You focus in this case on balancing the key principles of respect for autonomy and beneficence or best interests. Based on the discussion with the team and Mr. Hendricks’ nephew’s description of his uncle, you view the previously-expressed wishes to be more authentically Mr. Hendricks’. You and are concerned that the dementia has affected Mr. Hendricks in ways that make his current preferences less his in an ethically-relevant sense, such that respecting these wishes fails to respect his autonomy.
In the recommendations, you emphasize Mr. Hendricks’ earlier preferences as expressed in his advance directive as being representative of his autonomous desires. This means that he should receive no curative treatment and that all interventions will be palliative, but you don’t feel that this rules out Mr. Hendricks receiving the flu shot, as there are no indications that Mr. Hendricks didn’t want preventive interventions and he seems to be enjoying his current life. This acknowledges the role of the principle of beneficence and an understanding of Mr. Hendricks’ best interests that emphasizes the maintenance of health.
You acknowledge that this recommendation might be difficult for some members of the team to deal with, given the strong commitment that they have as health care providers to beneficence. Given that, there is a risk of them experiencing some Moral Distress as a result. You recommend that they convene another team meeting to discuss their responses to the situation and you make an offer of further support or Education.
You also mention that some members of the team might find this more challenging than others and encourage them to find ways to identify and discuss their value differences in respectful, productive ways. You mention that even when you feel you’re making an ethically appropriate choice, it can still be very hard, and that this is often the case in situation such as the one here when patients make choices that challenge us. You close by thanking the team of the discussion and reinforce that they displayed a high degree of ethical competence in the discussion.