Problem
In Julia's case, however, the fact is that she has been found to have the capacity to decide. If the nurses feed her regular food as she wishes, there is a good chance she will aspirate. The nurses would not be responsible for this outcome because they would be respecting her informed and freely made decision. Nonetheless, the situation would be distressing for them, and they could experience moral distress for the part they played in providing a form of care with which they strongly disagreed. The situation is bound to be stressful for all concerned: for Julia, for Mark, and for the nurses.
Task
A. Dining and food are associated with family, cultural, and religious values and can have symbolic meaning beyond mere sustenance. Julia appears to believe that her life would not be worth living without coffee, wine, and good food. Her partner believes that her decision to choose a high-risk diet over a much safer soft diet is irrational and proves that she lacks the capacity to decide. Do you agree with him that the decision by itself is sufficient evidence that she lacks capacity to make treatment decisions?
B. Nurses are taught that family-focused care is important. They are also taught that patients have the right to make their own decisions and not be coerced by family, friends, or caregivers. Discuss the ethical tension or conflict between these two things.
C. Can both the patient and the family be at the "centre" of nursing care? How would you apportion or distinguish the respective rights and responsibilities of patients, their families, and nurses in "shared decision-making."
D. Discuss the experience of stress or distress that can arise when nurses participate in a plan of care freely chosen by a patient but to which they are strongly opposed. How should nurses and employers manage such stress or distress?
E. Suppose that Julia goes on a hunger strike. After a week, she says she wants to die and asks for medical aid in dying. She is assessed and does not qualify. Julia decides to go home to continue not eating or drinking. Should she be permitted to go home?