Case Study Questions

Your friend is a nurse who is caring for Ms. Cranford. She is an 87-year-old mentally competent woman who has lived alone since her husband died 10 years ago. She was admitted to the hospital with chest pain, feeling faint, a pulse of 48, and a blood pressure of 98/56. The physician and nurses stabilized Ms. Cranford with medications and intravenous fluids but later informed Ms. Cranford and her only son that she would need a heart pacemaker to regulate her heartbeat. After the physician explained the procedure and risks involved, Ms. Cranford pondered the situation for a long while before discussing it with her son and the physician. Her medical history includes long-term adult-onset diabetes, chronic renal failure, and arterial insufficiency. She feels very tired. She decides that she does not want a pacemaker. Once Ms. Cranford tells her son her wishes, he is quite upset, and thus, he meets with the physician to discuss the options. The physician and Ms. Cranford’s son revisited this issue with her in an attempt to persuade her to change her mind, but she continues to refuse the recommended treatment. She and her son argue. The physician tries to explain to Ms. Cranford that the pacemaker is for her benefit, in her “best interest,” and involves very minimal risks to her. She feels as if they are “ganging up” on her.

Case Study Questions:
You are a nurse on the ethics committee consulted about Ms. Cranford’s case. Answer the following questions keeping in mind:
Ethics: patient is or is not mentally competent.

  • Who decides?
  • Who has the right to make her decisions? 

What is really important about this case for the professional nurse’ role?
1. What are the central ethical issues and questions in this case?
2. What did the physician mean by “best interest” for Ms. Cranford?
3. Use the Four Topics Method to discuss issues, to identify additional information that might be needed, and to analyze this case. What are your recommendations on behalf of the ethics committee?
4. What is the role of the nurses caring for Ms. Cranford in resolving this situation with the ethics team, her other healthcare providers, Ms. Cranford, and her son? 

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