In reading the article "Administrative Ethics: Perspectives on Patients and Community-Based Care," I feel the agency and administrator made the right decision in the case study of Mrs. R. I do believe it is the responsibility of the health care team to provide adequate care both legally and professionally. The Agency in the case study should, and did, provide considerable care as well as other alternatives for the patient and the family.
However, most responsibility should be placed on the family members, regardless of whether or not they live near to each other. The health care system cannot provide ongoing care for every individual when it is not feasible or safe for the patient for an agency to provide the care. When conflict arises between the patient and the provider and the patient/family refuses recommendations from the health care team, line drawing is the answer. Informing the patient and family so they know their options and letting them choose is the only alternative for the agency to provide. Sometimes in life you have to make decisions with the choices that are provided instead of choices you want. Drawing the line does not mean the health care staff is cruel or unethical. Caring can be demonstrated as health care providers stop enabling the patient to live unsafely. The hard facts need to be given to the patient/family to inform them of what will happen with each alternative. This approach still allows the patient and family to choose their care.
Lori Moya, BSN, RN
University of Texas at Austin