Case Study: Dementia
John Beauford is a 77-year-old divorced male. He moved to Florida after his divorce and has no contact with his former wife. He has no children, and his only sister lives in a distant state. They talk weekly on the phone but have not seen each other in several years. He attends church and volunteers at a community organization. He has several acquaintances but no close friends. Recently he has become increasingly forgetful but passes it off as a sign of aging. He is staying home alone more and more frequently, and often cannot remember whether he ate. He missed several meetings at the community agency because he forgot. When someone from the agency called him about his absence, he became angry and defensive, stating nobody told him there was a meeting. While driving home from church one day on a route he had taken numerous times, he became disoriented and lost. Trying to find his way home, he drove for more than 2 hours, failed to notice a traffic light, and was involved in a motor vehicle collision. He is transported to the emergency department of the closest hospital. He is unable to answer questions about his health history and becomes belligerent when different staff members ask him the same questions. However, he does not have life-threatening injuries, only some minor contusions. The emergency department staff find his driver’s license and Medicare card in his wallet, but no health information is available. There are business cards from the community agency. There is no information about Mr. Beauford in the computer system of the medical center. The healthcare team needs more information about his health history, current medications, allergies, and emergency contact(s). A computerized tomography (CT) scan of the head shows no head injury that would explain his behavior. A psychiatrist and social worker are consulted.
Discussion Questions
- How can the healthcare team obtain necessary information without breaching confidentiality?
- What are some ways the healthcare team can use to attempt to establish a trusting relationship with Mr. Beauford?
- Use a formal ethical decision-making process to determine what should be done regarding Mr. Beauford’s case and eventual discharge.
- How can the healthcare team obtain necessary information without breaching confidentiality?
To obtain necessary information about Mr. Beauford’s health history, current medications, allergies, and emergency contacts without breaching confidentiality, the healthcare team can take the following steps:
a. Contact the Community Agency: Since Mr. Beauford has business cards from the community agency, the healthcare team can reach out to the agency to request any available information about his medical history, medications, and emergency contacts. It’s possible that they may have some records on file that can provide valuable insights.
b. Contact His Sister: Since Mr. Beauford talks weekly to his sister on the phone, the healthcare team can ask him if he’s willing to provide his sister’s contact information. If he agrees, they can contact her to gather information about his medical history and emergency contacts.
c. Consult His Wallet: The healthcare team has already found Mr. Beauford’s driver’s license and Medicare card in his wallet. They can use this information to verify his identity and potentially contact Medicare to check if they have any medical records or contact information on file.
d. Seek Legal Consent: If Mr. Beauford’s condition allows, they can explain the situation to him and request his consent to access his medical records or contact his former healthcare providers. In cases where he may lack capacity to provide informed consent, they may need to explore legal avenues, such as obtaining a court-appointed guardian or conservator.
- What are some ways the healthcare team can use to attempt to establish a trusting relationship with Mr. Beauford?
Establishing a trusting relationship with Mr. Beauford is crucial for his care and cooperation. Here are some ways the healthcare team can attempt to build trust:
a. Empathy and Active Listening: Show empathy and active listening by acknowledging his feelings and concerns. Let him express his frustrations and fears, and validate his emotions.
b. Consistency: Assign a consistent healthcare provider or team member to interact with Mr. Beauford. This can help build familiarity and trust over time.
c. Respect Autonomy: Respect his autonomy and involve him in decisions regarding his care to the extent possible. This can help him feel more in control of his situation.
d. Establish a Routine: Create a daily routine for Mr. Beauford within the healthcare setting. Predictability can reduce anxiety and confusion.
e. Communicate Clearly: Use clear and simple language when communicating with him. Avoid medical jargon and provide information in small, manageable chunks.
f. Involve His Sister: If Mr. Beauford trusts his sister, involve her in discussions about his care and decision-making. Her presence or input may help reassure him.
g. Behavioral Health Specialist: Continue involving the psychiatrist and social worker who were consulted to address any behavioral or psychological aspects of his condition.
- Use a formal ethical decision-making process to determine what should be done regarding Mr. Beauford’s case and eventual discharge.
The ethical decision-making process involves several key steps:
a. Identify the Ethical Issue: The ethical issue in this case is the need to gather essential medical information to provide appropriate care and ensure Mr. Beauford’s safety.
b. Gather Information: Collect all available information about Mr. Beauford’s condition, preferences, and circumstances.
c. Identify Relevant Ethical Principles: Consider the principles of autonomy, beneficence, non-maleficence, and justice. In this case, balancing autonomy with the need to ensure his well-being is crucial.
d. Explore Options: Explore different courses of action. Options may include pursuing legal guardianship if he lacks decision-making capacity or seeking consent from his sister if possible.
e. Evaluate Options: Assess the advantages and disadvantages of each option in light of the ethical principles. Weigh the potential benefits and harms.
f. Make a Decision: Based on the evaluation, make a decision that respects Mr. Beauford’s autonomy and prioritizes his safety and well-being.
g. Implement the Decision: Put the decision into action, which may involve contacting his sister, seeking legal guardianship, or exploring other avenues to obtain necessary information.
h. Review and Reflect: Continuously review the situation and adapt the plan as needed. Ethical decision-making is an ongoing process.
The goal is to ensure Mr. Beauford receives appropriate care while respecting his autonomy and dignity to the greatest extent possible. The decision should be made in his best interests while considering his values and preferences, even if he is unable to communicate them clearly.