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Cassandra’s Refusal of Chemo: Nurse Ethicist Ponders Ethics of Forcing Treatment

Douglas Olsen is an associate professor at the Michigan State University College of Nursing in East Lansing and a contributing editor of AJN, where he regularly writes about ethical issues in nursing.

scalesThe case of Cassandra, a 17-year-old female in Connecticut being compelled by the court to undergo chemotherapy for Hodgkin’s lymphoma, has aroused interest in the media and among bioethicists, who have offered mixed conclusions. (Here’s a recent update on Cassandra’s legal status.) For example, Ruth Macklin concludes that the actions taken to force the treatment were not justified, while Arthur Caplan concludes that compelling her to have the chemo is justified. Both are scholars of the highest order.

I agree with Caplan that she should be given the chemotherapy, but my purpose here is to illustrate that perspective plays an often unacknowledged role in ethical analysis. When feelings and personal perspective go unacknowledged, the analysis loses credibility and depth.

The principles in conflict in this the case are straightforward for ethicists: respect for autonomy versus beneficence.

As a society, we value control over personal choice, that is, autonomy, which would mean honoring Cassandra’s decision to forgo the chemo. The chief justification for overriding a patient’s autonomy is that the patient lacks decision-making capacity because she is a minor.

However, we also value doing what is best […]

2016-11-21T13:03:09-05:00January 21st, 2015|Ethics, Nursing, nursing perspective, patient engagement, Patients|1 Comment
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Long-Distance Coaching

Patrice Gopo is a writer living in North Carolina.

The author Patrice Gopo

Moments ago I’d been crouching on my bed, but now I lay wrapped in a thick duvet. My panting began to slow to a normal cadence. Then a sharp rush. My midsection hardened, followed by intense cramping. With a swift motion, I moved from lying on the bed back to all fours.

“Find your point and focus.”

I heard my mother’s words through the speakers of the computer. My eyes locked on where the edge of the metal curtain rod met the white wall.

Around me, voices and images drifted away.

Before I gave birth to my first child, I didn’t know that between a tightening abdomen and waves of pain, Skype conversations were possible.

While I appreciated that technology could bring someone distant close, my mother wasn’t supposed to be a face on the computer. She was meant to be by my side and not in a living room 10,000 miles away. But my daughter had decided to slide down the birth canal 12 days before expected.

My mother describes herself as a practical person. “I’m a nurse. It’s in the job description,” she often says. When pregnant with her own firstborn—my older sister—her contractions began in the midst of an overnight shift in the labor and delivery unit. She completed the night’s job before […]

2016-11-21T13:03:15-05:00January 9th, 2015|Nursing, nursing perspective, patient engagement, Patients|2 Comments
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‘Suppose a Client Went Out of His Room’: Study Explores RNs’ Use of Surveillance Technology in Residential Facilities

By Sylvia Foley, AJN senior editor

“If people are for instance walking around in the units, well, then they could do all sorts of things . . . ”—study participant

Table 2. Surveillance Devices and Their Use in the Selected Care Facilities Table 2. Surveillance Devices and Their Use in the Selected Care Facilities

Surveillance technology in residential care facilities for people with dementia or intellectual disabilities has been touted both as a solution to understaffing and as a means to increasing clients’ autonomy. But it’s unclear whether surveillance technology delivers on its promises—and there are fears that its use could attenuate the care relationship. To explore how nurses and support staff actually use this technology, Alexander Niemeijer and colleagues decided to conduct a field study. They report on their findings in this month’s CE–Original Research feature, “The Use of Surveillance Technology in Residential Facilities for People with Dementia or Intellectual Disabilities.” Here’s a brief summary.

Methods: An ethnographic field study was carried out in two residential care facilities: a nursing home for people with dementia and a facility for people with intellectual disabilities. Data were collected through field observations and informal conversations as well as through formal interviews.
Results: Five overarching themes on the use of surveillance technology emerged from the data: continuing to do rounds, alarm fatigue, keeping […]

2017-07-27T14:43:52-04:00December 15th, 2014|nursing research|0 Comments
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Always a Nurse

By Janice M. Scully. The author worked in psychiatric nursing for four years before becoming a physician. After 20 years as a physician, she retired to pursue a career as a writer. For more information, click here.

The author's parents The author’s parents

Nurses have to be resilient and resourceful—Florence Nightingale,  of course, is the template. My mother, Betty, was a smart and practical woman, the oldest of three siblings. She attended nurses’ training in the 1940s while the Second World War raged overseas. I have a photo of her as a young woman just out of high school, dressed in her starched uniform, standing by Binghampton (NY) City Hospital, her alma mater.

According to her, the lives of young nurses back then were not unlike the lives of nuns. After lights out in the dorm, the dorm mother would walk through and shine a light on each bed, as a night nurse on a medical ward at 2 AM might do. But instead of observing for signs of life, dorm mothers were checking to be sure the young female nurses were in their beds. Sometimes they weren’t.

Although the students might not be allowed out at night, they had a great deal of responsibility during the day. Nurses did everything for the sick, even the hospital laundry. They gave bed baths and back rubs […]

2016-11-21T13:03:31-05:00November 19th, 2014|career, Nursing, nursing perspective|4 Comments
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How Do RNs View Palliative Care for Hospitalized Older Adults? What a Study Reveals

By Sylvia Foley, AJN senior editor

“I think [palliative care is] also for that portion of the population that falls in the crack, in terms of, they’re not quite ready for the hospice thing but they’re not really ready for new aggressive chemo or anything else. … They’re in that vague no man’s land of where they fit in terms of services.”—study participant

Timely referral to palliative care could potentially benefit many seriously ill, hospitalized older adults. Such care not only offers relief from disease symptoms, but also helps patients and families to reach personal goals, reconcile conflicts, and extract meaning from their varied experiences. Yet those who might benefit are less likely to receive such care if their providers are unclear about the concept and how it differs from hospice care.

Table 5. Five Main Thematic Categories with Associated Subcategories Table 5. Five Main Thematic Categories with Associated Subcategories

To learn more about how staff nurses understand and manage palliative care, nurse researcher Maureen O’Shea decided to conduct an exploratory study. She reports on the findings in this month’s CE–Original Research feature, “Staff Nurses’ Perceptions Regarding Palliative Care for Hospitalized Older Adults.”

Here’s a quick overview. […]

2017-07-27T14:44:09-04:00November 17th, 2014|nursing perspective, nursing research|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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