Table 4 Scenario outlines
Scenario 1: Refusal of treatment stemming from being mentally trapped |
|---|
Time span: approximately 1 h Client: Head Nurse This case involved consultation on how to deal with a 35-year-old male patient on dialysis due to diabetic nephropathy. The patient was hospitalized for a shunt reconstruction, but he became depressed and mentally trapped by his situation and started refusing to receive catheter dialysis. Moreover, he was also causing problems by verbally abusing his wife and nurses. The assignment of the consultation was to determine whether it is ethical to recommend discharging the patient from the hospital if he refuses to receive shunt revision surgery. |
Scenario 2: Refusal of treatment for religious reasons |
Time span: approximately 1 h Client: Nurse in-charge This case was a consultation regarding the treatment of a 40-year-old female patient admitted to the cardiology department for pulmonary hypertension. The patient needed a percutaneous cardiopulmonary support system (PCPS), but she refused it for religious reasons. However, the attending physician did not care about the patient’s wishes and tried to obtain informed consent from the family to proceed with PCPS because the patient was also being treated for schizophrenia. The details of consultation were regarding what steps to take to be there for the patient. |
Scenario 3: Refusal of standard treatment stemming from an attitude of avoiding self-determination |
Time span: approximately 1 h Client: Attending physician (gastroesophageal surgery) This case was a consultation on how to deal with a 70-year-old female patient who was hospitalized for stomach cancer. The patient had started to avoid making decisions on her own after her husband’s suicide, and has refused the standard treatment proposed by her doctor for her stomach cancer, following the advice of her eldest son, who recommends non-standard treatment. The patient’s only stated wish was that she did not want to be transferred to a different hospital. The assignment of consultation was how to deal with the patient’s reluctance to be transferred to a different hospital. |