For the last few days, you have been taking care of Mr. Cole, a 28-year-old patient with end-stage cystic fibrosis. You have developed a caring relationship with Mr. Cole and his wife. They are both aware of the prognosis of his disease and realize that he has only a short time left to live.
When Dr. Jones made rounds with you this morning, she told the Coles that Mr. Cole could be discharged today if his condition remains stable. They were both excited about the news because they had been urging the doctor to let him go home to enjoy his remaining time surrounded by the people he loves.
When you bring in Mr. Cole’s discharge orders to his room to review his medications and other treatments, you find Mrs. Cole assisting Mr. Cole as he coughs up bright red blood. When you confront them, they both beg you not to tell the doctor or chart the incident because they do not want their discharge to be delayed.
They believe that it is their right to go home and let Mr. Cole die surrounded by his family. They said that they know that they can leave against their physician’s wishes and go home against medical advice, but if they do, their insurance will not pay for home care.
To See or Not to See
What is your duty in this case? What are Mr. Cole’s rights? Is it ever justified to withhold information from the physician? Will you chart the incident, and will you report it to anyone? Solve this case, justifying your decision by using ethical principles.
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