Question

Shamus’s family come to talk to you about their his care.

They want to speak to you because they trust you as someone who has worked very closely with Shamus as a palliative care worker for the last two months.

They are very distressed about a report they have received from the doctor, who has told them that Shamus has only days to live.

His family ask you to refer them to a different doctor – there must be something that can be done to preserve his life. They aren’t ready to lose him yet!

Shamus has an advanced care directive. It states he does not want any further medical treatment to keep him alive.

His family are aware of this directive.

1.You feel that people have the right to get a second opinion. Should you refer Shamus’s family to a good doctor that you know? Explain your answer

2.What other action could you take to support Shamus’s family?

Shamus has died.

His wife, Katherine, comes to see you and thanks you for looking after him so well.

She gives you a hug and you both feel a bit sad.

Katherine tells you that she seems to be living in a daze. She can’t even remember what she did this morning. She is usually so well organised but just can’t seem to concentrate at the minute – what if something goes wrong at the funeral because she forgets to do something?

‘I haven’t even cried yet!’ she exclaims.

1. Why is Katherine experiencing this type of reaction so soon after her husband’s death?
2. What would you say to Katherine to reduce her fear of something going wrong at the funeral?
3. What are the five stages of grief according to the Kübler-Ross Grief Cycle?

A client’s family is looking for some information on palliative care. They have received the information provided by the HACC team but they are looking for more.

Research the Internet and find a reputable source of information that they can access to find out more. Write down the source of this information (ie the website address).

Bessie has severe dementia.

Before she got dementia, she had written out an advanced care directive that said that she wanted to be resuscitated by CPR if she collapsed under any circumstances.

As far as Bessie was concerned, life was more important than anything else – even if she wouldn’t be able to make her own decisions as her dementia progressed.

Bessie’s son has not been to visit her for months. One day he appears at Bessie’s side. ‘I’m the only next of kin,’ he says. ‘Mum isn’t here anymore, she’s just a vegetable now. I don’t want her to be resuscitated if she collapses again. Just let the old lady die.’

You are aware that Bessie is a very rich woman. From the look of her son, he could do with some money.

1. What are the ethical issues involved in this scenario and what action should the care worker take?
2. Describe three legal and three ethical issues that may arise with advanced care directives and suggest to deal with these.

Bessie’s son begins to ask a lot of questions about his mother:

• ‘What is the matter with her?’
• ‘How sick is she?’
• ‘Does she know who anyone is anymore?’
• ‘Where is all her bank paperwork?’

Bessie’s son assures you that he has a power of attorney for Bessie – but he does not show you a copy.

1. Bessie’s last surviving relative is her son. Considering he says he has power of attorney, do you think you can give him any of the information he has asked for? Explain your answer.

Answer 1

Shamu's family can be reffered to an other Doctor , because every patient has the' Right to second opinion'.
Every patient or Patient family can take a second opinion if they feel the need to, its actually a right given to the patient to choose what is best for him/her.
The patient or family can even obtain better information or different options through second opinions.

The other things that can be done to support the family is To keep the communication open between the doctors, staff and the patients family.
To update about the patients conditions to the family. .  To include the near and dear ones for patient care.

a. Katherine is experiencing these feelings because of grief.

b. Katherine needs support, mental support is very important. So make sure to tell her words of affirmation.

c. The 5 stages of grief are

Denial

Anger

Bargaining

Depression

Acceptance