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17. Case: Too Much to Expect?
View Case: 17. Case: Too Much to Expect?92-year old Ellie MacPherson has recently moved to a long-term care facility. She had found that the increasing difficulty she was experiencing due to arthritis with getting dressed, making her meals and getting out of the house meant that she could no longer live on her own. Ellie brought a number of her favourite clothes…
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16. Case: Shifting Gears
View Case: 16. Case: Shifting GearsNedra has been fighting ovarian cancer for 3 years. When first diagnosed, Nedra had surgery followed by intensive chemotherapy. Although it initially looked like she might be moving into remission, things started to change about 6 months ago. Nedra started experiencing some bone pain and it was discovered that her cancer had metastasized. Although radiation…
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15. Case: Acceptable Judgement?
View Case: 15. Case: Acceptable Judgement?Sara Thornton, an unemployed 19-year old woman, lives with her 28 year old sister, Fran, and Fran’s boyfriend, Alan. Both sisters were diagnosed with bipolar I disorder in their mid-adolescence. They are both estranged from their alcoholic mother, the only living parent. Fran has learned to manage her illness reasonably well through lifestyle changes, participation…
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14. Case: I Want to Go Home!
View Case: 14. Case: I Want to Go Home!A widower (age 88) lives alone, but has family living nearby. Recently he had a stroke and regained consciousness after being admitted to hospital. He was deemed to have cognitive capacity. His adult children approached the physician in charge of his case along with the unit’s Nurse Manager and requested that the patient be placed…
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13. Case Mind Over Matter?
View Case: 13. Case Mind Over Matter?Essie Marshall is well-known in the community for her many years of dedicated volunteer work and leadership. She is also well-known in the emergency department for her frequent visits. As one of the doctors describes her, “She’s a challenging patient, but not in the medical sense.” Today Essie is back in the emergency department, saying…
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12. Case: Should Steve Go Home?
View Case: 12. Case: Should Steve Go Home?Throughout his life, Steve was the athlete that everyone admired. He played all sports well, especially excelling at basketball. While being quite competitive, Steve was a team player who enjoyed being a part of the team experience. Unfortunately, while ‘horsing around’ with his friends last summer, Steve dove off a dock into water that was…
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11. Case: Truth-Telling
View Case: 11. Case: Truth-TellingThe patient is an 89-year-old gentleman with moderate dementia and a history of COPD, swallowing difficulties, a CVA, and recent aspiration. The investigation of his aspiration uncovered a lesion in his lung- the physicians felt it was likely to be cancerous. Thoracic surgery verified that it was lung cancer and a determination was made that…
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10. Case: At a Crossroads…
View Case: 10. Case: At a Crossroads…Sandra Livingstone, age 45, was admitted to the hospital with diffuse ischemic encephalopathy – a very significant, global brain injury – secondary to sustaining a massive stroke at home. It is now ten months after her admission. Ms. Livingstone is on an acute internal medicine unit where she has been living since her discharge from…
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9. Case: Right to Treatment
View Case: 9. Case: Right to TreatmentA 54-year-old male patient has been treated for cancer for 2 years, but his illness has not responded to the major lines of treatment. He has been admitted to hospital with worsening nausea and vomiting, abdominal pain, and failure to thrive. A CT scan showed progression of disease as evidenced by new ascites along with…
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8. Case: Who Should Decide?
View Case: 8. Case: Who Should Decide?This case concerns a 35-year-old developmentally delayed female patient (functional age about 5 years old); her mother is her legal guardian. The patient tested positive for a BRCA gene mutation. Her mother is concerned that her daughter may develop ovarian cancer and wants her to have preventive surgery. Her physician does not believe this is…
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7. Case: Unknown Risks
View Case: 7. Case: Unknown RisksA person who was a first responder at an accident comes into the Emergency Room with blood/body fluid on himself. The patient who was involved in the accident was immediately sent to Halifax where he later passed away. His family had refused to allow his blood to be drawn for testing. The first responder is…
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6. Case: To Feed or Not to Feed?
View Case: 6. Case: To Feed or Not to Feed?You receive a call on the ethics line about a patient’s relative (next-of-kin and legal decision-maker) force-feeding her sister who is a patient on the unit (pushing food into the patient’s mouth and then holding her mouth closed, pinching her nose, etc. until she swallows). Apparently, this was not an uncommon approach to getting her…
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5. Case: Caring for a “Difficult” Patient
View Case: 5. Case: Caring for a “Difficult” PatientA female patient in her mid-forties has been on the GI service for several months now due to severe Crohn’s Disease, which has left her with multiple draining abdominal fistuli. She has recently moved out of the province but her condition could not be treated adequately in the local hospital so she was transferred back…
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4. Case: Expectations for Care
View Case: 4. Case: Expectations for CareNed is an elderly patient with relatively advanced dementia who is recovering from surgery to repair a hip fracture. He spends most of every 24-hour period screaming unless someone familiar sits with him. Staff members on the unit are becoming increasingly frustrated and stressed. The unit manager has received numerous complaints, verbal and written, from…
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