mental health – Ethics In Practice

Harm Reduction in the Hospital

Dora is a patient in her thirties. She is an inpatient on a regular medical/surgical unit at the University hospital. Years ago, she was in a car accident and sustained a spinal-cord injury and she is now a paraplegic. As a result, Dora uses a wheelchair to get around. She is in the hospital for IV antibiotic treatment because of a blood infection the doctors suspect was caused by her opioid use. She began using after the car accident. Her antibiotic treatment is delivered via a PICC line (peripherally inserted central catheter). Normally, a patient requiring this treatment could receive antibiotics at home. But Dora will not let community health nurses into her house, and due to her IV drug use it is uncertain or unlikely that she will be present at home when she needs to receive her antibiotics. The care team has determined that being an inpatient at the hospital will make it more likely she will receive her...

Difficult Discharge

It is Thursday afternoon. You receive a call from one of the hospital Discharge Planners, Zahra. Zahra requests your assistance with decision making about a patient named Mr. Roberts. She provides you with a summary of what has happened since Mr. Roberts was admitted to the hospital six weeks ago. Zahra explains that Mr. Roberts is an 83 year old who police brought to the hospital six weeks ago. The police had received a call about an elderly man walking back and forth on the same street over the course of two hours during a snowstorm, without a winter coat or boots. The police told the Emergency Department staff that Mr. Roberts was unable to tell them his address, and that he appeared disoriented and confused. Mr. Roberts was admitted to hospital with a urinary tract infection (UTI), delirium, and ‘failure to thrive.’ Dr. Suleman identifies and contacts Mr. Roberts’ substitute decision makerDr. Suleman was Mr. Roberts’ physician on admission to the...

Help me, please!

A mental health therapist, Cathy, working in a rural clinic, receives a phone call from a 42-year-old client, Emma. Cathy has met with Emma on only two occasions - once for the initial mental health assessment and one treatment session. The mental health assessment found that Emma has suffered from depression for many years. Emma has made two serious suicide attempts in the past with intent to die. In the last attempt, 1 year ago, Emma jumped off of an overpass and broke both her legs. Hospitalization was needed as she required multiple surgeries. Five weeks ago, her mom was growing increasingly worried about her daughter and brought Emma to the hospital. Emma was admitted to a nearby urban hospital in a psychiatric unit due to depression and suicidal ideation. She was just released from hospital three days ago. On the phone with her therapist, Cathy, Emma states that even though she was just released from hospital she still has suicidal...

Now and Then

Mr. Hendricks is a 58 year old with early-onset dementia that has progressed rapidly in the last three years. He is living in a continuing care facility with a nephew, Frank, as his substitute decision maker. Mr. Hendricks has an advance directive, written twenty years ago, which specifies that if he were to develop dementia he wishes to refuse any interventions aimed at cure, including antibiotics for pneumonia, and states that he would find a life with moderate or advanced dementia not worth living. Cold and flu season is coming up, and staff at the continuing care home are wondering what their responsibility is if Mr. Hendricks develops pneumonia as well as whether Mr. Hendricks should receive the annual flu shot. Their concern is amplified because, contrary to Mr. Hendricks’ expectations, he seems to find considerable pleasure in his life with worsening moderate dementia. Frank, Mr. Hendricks’ nephew, lives two provinces away and says that while they had a loving relationship, he...