Question

The patient is a 91-year-old man who had been in a long-term care facility for eight months. Before he was admitted, he was living alone and had experienced serious osteoarthritic and osteoporotic pain for a few years. His adult son and daughter arranged for his admission to a long-term care facility because they believed he could not manage his needed medications, and that he was not eating or caring for himself properly. At the time of admission, there was no evidence to suggest the patient had any cognitive deficits. The patient’s adult children shared with the facility that he became a constant complainer just a few years ago. The facility staff has branded him a complainer, and they attribute much of his complaints to his disagreeable nature. He currently receives two acetaminophen tablets every 4 hours, which he states does not adequately control his pain. He reports his pain is still too extreme to walk or to remain in a wheelchair for more than a half hour. As a result, he remains in bed a majority of the day and frequently requests help to reposition himself. The patient’s daughter registered a complaint with the state regulatory agency that the facility staff is neglecting her father and not taking care of his pain. The patient’s son asked the doctor to administer Nalfon, a nonsteroidal anti-inflammatory drug that he read about on the Internet. The doctor agrees to try it. The son also requested that the doctor not administer the same drug that his father received 8 months ago (at the time of admission) that relieved his pain but caused him to be physically and mentally sluggish. The patient, however, has requested that drug because it relieved his pain. After just a few weeks on Nalfon, the patient has dark, tarry stools, began vomiting blood, and he is hospitalized for a severe gastric bleed. Using each a utilitarian, duty-based, and virtue-based ethical theory, perform an ethical decision-making analysis as to whether the doctor’s decision to comply with the request of the patient’s son to administer Nalfon was ethical.

Answer 1

The ethical decision by the doctor to prescribe Nalfon is analyzed using three ethical theories. Utilitarian ethics question the balance of pain relief versus harm, duty-based ethics looks at the doctor's obligations and possible harm, and virtue-based ethics considers the moral character involved in the decision. Given the patient's severe reaction to the medication, it may not have been the most ethical choice.

Step-by-step explanation:

The ethical considerations of the doctor's decision to prescribe Nalfon, a nonsteroidal anti-inflammatory drug (NSAID), to a 91-year-old patient at the request of the patient's son involve analyzing the consequences and duties involved in such a decision. Utilitarian ethics would assess the overall happiness or utility generated by this decision. It would question whether the pain relief provided by Nalfon outweighs the potential for harm, such as the severe gastric bleed that the patient experienced. Duty-based ethics would consider the doctor's obligations to respect the patient's autonomy and the son's wishes while also doing no harm to the patient. Finally, virtue-based ethics would reflect on the character of the doctor and the moral excellences that should come into play, such as compassion, wisdom, and justice, in making medical decisions.

Given the serious side effects associated with NSAIDs, particularly in the elderly who may have an increased risk for gastrointestinal bleeding, the decision to prescribe Nalfon without adequately considering safer alternatives or the patient's past experiences with such medication may not align with utilitarian principles of maximizing happiness. Duty-based ethics might criticize the doctor for disregarding the potential risks of NSAIDs known in geriatric medicine. From a virtue-based perspective, the doctor's decision may lack the necessary prudence and care required when treating a vulnerable patient.