Reference no: EM133429698

Ann is a 68-year-old woman. She lives with her husband Andrew, age 79, in a modest bungalow in a rural area about 10 minutes from town. Andrew was diagnosed with lung cancer with metastases to liver and bone 10 months ago. Andrew had been feeling unwell for several months before seeking medical attention. He now is very weak and spends most of his time in bed. He has pain that is poorly controlled and eats very little. At times, he is quite confused. There is a suspicion that he has brain metastases but his wife and family feel there is no need for further investigations. His physicians agree.

Ann was born in New Zealand, and she has several brothers and sisters still in Wellington.

Ann and Andrew have been married for 46 years. This is Ann's second marriage. She was married for 2 years to John, who was killed in a car accident Ann was left with one child; a daughter Isabel now aged 50. Three years after John's death she met Andrew at work, and they married two years later. Ann and Andrew had three children, a son Alistair now age 43, a son Jean aged 36 and a daughter Michelle who died because of suicide 10 years ago at age 24. Isabel and Alistair both live in towns nearby but Jean lives interstate. Ann and Andrew have 8 grandchildren.

Andrew has been a heavy smoker for many years. He has had hypertension and ischemic heart disease for about ten years. He was a heavy drinker for a number of years but he stopped when Ann and he separated for a brief period. He does not drink alcohol now. He worked as an accountant with his own small office serving small businesses and doing income tax work. He is Scottish and has two brothers in Scotland. He and Ann used to visit them frequently. He is worried about how Ann will cope after he dies.

Ann has had rheumatoid arthritis for many years but was able to continue working as retail clerk until about 10 years ago when she had a flare-up of her disease. She is on multiple medications but has been able to do normal activities of daily living reasonably well with Andrew's help especially with household tasks. She is concerned about how she will be able to cope without Andrew's help. She does not want to bother her children for help. She has had to cope with the death of her first husband and her beloved daughter Michelle and feels that she cannot cope with another death in the family.

Their marriage has been quite strong despite the one brief separation. For two years after the death of their daughter Michelle, they grieved quite openly, and they recovered slowly. Their children have been very close despite two of them living far away. They are both Roman Catholic and have attending church regularly. They live on their pensions now.

You are seeing Ann and Andrew for the first time.

Question

What ethical issues might be relevant for working with this client? Here, I am working as a social worker.