In the last edition of the Ethics Network News we published the very first Ethics Issue which dealt with the issue of intubation and the Health Care Proxy. Many thanks to NYCLTCEN Board Member, Dr. Ellen Olson, for providing a very detailed and insightful response to the Ethics Issue. Our new Ethics Issue pertains to a very real dilemma that you may have faced in your own long-term care facility namely, who will be the recipient of the private room that has just become available? Please let us know what you think and how you would respond to the following Ethics Issue:
Shady Groves SNF, like many older homes, was built with two and four bedded rooms plus a small number of private rooms. Last night Mrs. Q died quietly in her sleep after living the final 11 of her 98 years in her own room at Shady Groves. Staff is now assembled todecide who will be transferred to this scarce resource.For the Director of Admissions there is no issue. Mr. P has been on the list for more than three years. "His wife made me promise he would get the next available private room and it's his turn. Fair is fair, he deserves it. What's the point of keeping a list if you don't follow it?" But other staff point out that Mrs. P died two years ago, that Mr. P's dementia is now so advanced that he could not possibly benefit from the single room while he might suffer from losing the CNRs who know him and who he, possibly, recognizes.
For the Director of Social Work the case is equally clear. Ms. O is an extremely private women who is suffering terribly from having to share a room with others. She is becoming depressed and tearful. Even though she has only been here a few months, her need is greatest. "Our mission is to serve the needs of our residents. Ms. O should get the room."
The Administrator is willing to accept whatever the team decides. But it wouldn't make me at all unhappy if the damned N family finally got their mother a private room and stopped calling me." At this point the Medical Director leaves. "Call me when you decide."
The Director of Nurses points out that if we only moved Ms. M to the room, her three current roommates and the staff on her floor would have a party. "She's up all night demanding things, she keeps everyone else up, and OBRA says we can't medicate her to shut her up. With our lousy call bell system we can't tell which resident in the room is ringing until we go to the room and check them all. A private room would allow us a serious behavioral management plan for her, would benefit three residents and meet the needs of the staff. Don't the staff needs matter at all here?"
The Director of Pastoral Care also has a suggestion. "Mrs. K is dying of breast cancer. She's only 63 and her children are all visiting constantly and her husband, who is overwhelmed, is practically living here. She has issues to resolve with her God and with her family and good-byes to say. I know we have offered them the chance to meet privately in a lounge, but she is in too much pain when she tries to transfer and when we give her enough pain medicine to handle sitting up it makes her drowsy. Our call is not just to serve our residents but to serve mankind. Don't her spiritual needs and the needs of her family count?"
At this point the Director of Development makes another suggestion. "The L family is very rich. They want Mama L to have a private room. They have already bought a van for the home which we use to take residents on trips. They are discussing the possibility of redecorating all the resident lounges. While I'm not suggesting that the rich are more deserving, didn't John Stuart Mill say the right choice is that which provides the greatest good to the greatest number? Surely that would mean Mrs. L."
The Administrator suggests that the Ethics Committee could resolve the issue. "I just want to do what's right and just."
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