Reference no: EM132469875

Doris, a widow 75 years of age, lives alone in a suburban bungalow that she and her late husband owned for 30 years. Her few close friends have died in the past few years. She has two grown children, a son and a daughter, both of whom live in another city. Over the past six or seven months, Doris's general health has declined. She has lost weight, has grown weak, and finds it difficult to leave home to go about her daily activities. One particular week, Sam, her postman, notices that Doris's mail has not been taken in for two days. Sam is concerned; he knows Doris's daily routine, and she always informs him when she plans to go out of town. He knocks on the door but receives no answer. Alarmed, Sam calls the police, who, upon arrival at Doris's home, discover her lying semiconscious on the kitchen floor. Doris is rushed to hospital. The attending physician makes a preliminary diagnosis of gastrointestinal bleeding and, since it is an emergency, orders a blood transfusion to stabilize her. A few days later, Doris is alert and apparently competent, but the nurses caring for her have noted some occasions when she seems confused as to her surroundings and does not know what day it is. The physician tells Doris that her condition urgently warrants further tests. She becomes agitated and upset, fearing that the doctors will discover cancer and that she will soon die. Consequently, she refuses to authorize the tests. The members of the team know that any number of easily treatable factors could be causing the bleeding, and they are concerned that Doris's refusal of further investigation and treatment is not in her best interests. Some nurses question whether Doris, in her present state of mind, is capable of making such a decision. The team wishes to involve her children, but Doris refuses to give any information that would enable contact. She does not want her family involved; she feels she has always been able to take care of herself and does not wish to worry her children. Over the next few days, the team finds evidence that Doris's bleeding is recurring. Something must be done soon or she may die.

Answer the following Questions:

1. Does Doris have the mental (and hence legal) capacity to make the decision to accept or refuse treatment?

2. Has Doris been given adequate opportunity to make an informed decision with respect to consent to treatment?

3. May the nurses or other team members legally and ethically disclose information pertaining to Doris's condition to her children, assuming they are able to contact them through their own efforts?

4. What are the competing ethical interests in this situation, and how can they be resolved?

5. May the team proceed with the investigation of Doris's condition on the assumption that she is not capable of giving or withholding consent?