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 in a nursing home. The patient was clear and firm in his desire to return to his own home.

The team has requested a clinical ethics consult.

  • What are the main ethics issues at stake here?
  • What steps would you take to help the patient, family and health care team come to a decision?
  • How should risk and quality of life be balanced/reconciled in this situation?
  • Who else should be a part of this discussion?

Some Values and Ethics Issues to Consider

  • Capacity
  • Patient-family relationships
  • Substitute decision-making
  • Living at risk
  • Patient-centered care
  • Empathy
  • Patient safety
  • Community health ethics
  • Respect for patient autonomy
  • Respect for individual liberty
  • Respect for human dignity
  • Quality of life

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