Please read the case study below and complete a two page word document using MLA format and citing sources, which responds and clarifies to the following:
Consider the eight principles of ethics – Autonomy, Nonmaleficence, Beneficence, Justice, Fidelity, Confidentiality, Veracity and Accountability. Which of these are at issue and explain your response as it relates to the case study.
What would you do ethically and legally??
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Dr. Wayne is on bi-weekly rounds at the Greenacres Retirement Home. He picks up the chart for Mr. Hooper, a 75-year old man with dementia and congestive heart failure who was admitted almost 5 months ago. The nursing staff had specifically asked for Mr. Hooper to be seen because he has developed a pressure ulcer on his sacrum that has not been responding to standard treatment.
Dr. Wayne reviews the information in the chart: Mr. Hooper was living at home prior to suffering a heart attack 6 months ago, after which his congestive heart failure became markedly worse. Mr. Hooper then went through a few weeks of cardiac rehab with minimal results before being sent to Greenacres, where he has had 2 months of physical therapy, again with marginal results. Dr. Wayne looks over his physical therapy notes. Based on a review of the chart it seems that Mr. Hooper is getting worse. Although he is on Aricept and Haldol, Mr. Hooper’s dementia often makes him combative. Now a pressure ulcer has developed, possibly complicating the care plan.
Two nurses accompany Dr. Wayne and help to position Mr. Hooper so the ulcer can be examined. It’s extensive but doesn’t appear to extend to the bone or need much debridement. After examining the wound Dr. Wayne begins discussing a treatment plan with the nursing staff. During the discussion Mr. Hooper’s wife and son enter the room.
“Dr. Wayne, we’re glad you’re here. We wanted to discuss my husband’s skin breakdown,” Mrs. Hooper says.
Dr. Wayne explains that the skin breakdown is significant, but he believes it can be handled by the wound care team at Greenacres. It is in a sensitive area, however, and if it seems to be going into the bone or developing a lot of necrosis, he probably will need to be hospitalized.
“Well, Dr. Wayne, that’s something we wanted to talk to you about too,” Mr. Hooper’s son begins. “Dad has Medicare, but it doesn’t cover the nursing home costs now, and we’ve been paying for his care out of his savings. We’re working on getting Mom and him on Medicaid, but right now they don’t qualify. We don’t think we’re going to be able to afford to keep him here much longer if we don’t have some kind of help, and mom can’t manage him at home.”
Dr. Wayne agrees that it would be difficult for Mrs. Hooper to care for her husband at home.
“What I’m saying, I guess, is could you admit him to the hospital for this now? If he’s in the hospital Medicare will pay for it and then will pay for another 90 days in the nursing home for rehab. By that time we should have Mom and Dad’s Medicaid application sorted out. Besides, you said you think he’s probably going to be hospitalized for this anyway.”