Consider the following situation: MS is an 89-year-old woman with a history of advanced Alzheimers type dementia, HTN, recurrent UTIs, and recurrent aspiration PNA who presents to the ED with progressive failure to thrive over the last 4-6 weeks.

Ethics Assignment NU632
Consider the following situation: MS is an 89-year-old woman with a history of advanced Alzheimers type dementia, HTN, recurrent UTIs, and recurrent aspiration PNA who presents to the ED with progressive failure to thrive over the last 4-6 weeks. History is obtained from the patients daughter, Stacey, as the patient is minimally verbally responsive due to her underlying dementia. Stacey is the primary caregiver for her mother. Over the last few weeks, Stacey describes an overall picture of decline for her mother marked by increased lethargy, decreased interaction/verbal responses, weight loss, decreased intake of fluids and food with weight loss of >10%, and recurrent infections. Stacey also notes that her mother has been pocketing nearly all food and pills despite frequent cuing. The patient is completely dependent in all ADLs and is bedbound. She requires full assistance for all meals and has lost interest in eating. Infectious work-up reveals CXR (+) for RML/RLL consolidation suggestive of aspiration PNA. Speech therapy is recommending strict NPO status. Stacey provides a copy of her mothers advance directives to the hospital as requested. The advance directive states that if MS were deemed to be in an end-stage medical condition, she would not want life prolonging measures such as CPR, mechanical ventilation, or artificial hydration and nutrition. The directive also names Stacey as the healthcare agent for MS and gives her the power to make decisions on her behalf. Stacey requests evaluation for a feeding tube so her mother doesnt starve to death. An ethics consult is requested.
Instructions:
1. Chose a scenario (from section A, below) to write a reflection paper on.
i. **You must note the Scenario you are discussing at the start of your submission. (For example, Scenario #1: Dementia is considered)
2. Must include discussion of a minimum of 2 ethical principles (chose from below) in your written assignment
3. Include 2 peer reviewed, evidenced-based references.
i. You must include at least one reference that is different from the articles posted on the course board.
4. Submission must be in APA format, no more than two pages (not including reference page). A title page is not mandatory.
5. Assignment must be submitted in word file format (.doc or .docx)

A. Key ethical principles: You must include discussion of a minimum of TWO of the following ethical principles within your paper and how it applies to your chosen scenario (see below).
Nonmaleficence: the duty to do no harm
Utilitarianism: the right to act is the one that produces the greatest good for the greatest number
Beneficence: the duty to prevent harm and promote good
Justice: The duty to be fair
Fidelity: The duty to be faithful
Veracity: The duty to be truthful
Autonomy: The duty to respect an individuals thoughts and actions, self-determination

B. Please choose one of the scenarios listed below to discuss in your paper (be sure to answer all questions included in the scenario):
1. Scenario #1: Is dementia a terminal condition? Is a PEG tube indicated in this patient? Why or why not? What are the ethical considerations of artificial nutrition and hydration in dementia? What is a potential patient outcome of initiating a PEG tube and artificial nutrition in patients with advanced dementia, such as with MG?
2. Scenario #2: Consider if this were 3-5 years earlier (i.e. NOT yet end-stage dementia and patient with full capacity) and MS presented to your outpatient clinic and to discuss her consideration of Voluntary Stopping of Eating and Drinking (VSED), before the dementia gets worse What is VSED? How would you support the patient? Is VSED a viable option for patients? Why or why not? What ethical considerations does VSED pose to the practitioner?
3. Scenario #3: Consider an alternative situation of prisoners being force-fed at Guantanamo Bay (refer to attachments on Canvas assignment page). Is there any point when treatment, such as artificial nutrition and hydration, can or should be forced? Are nurses justified in their decision to refuse to carry out orders to force-feed? What is a potential patient outcome in the situation of force feeding in Guantanamo Bay? What ethical considerations would be in conflict? Explain.

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