Objectives

1. Identify the ways instruction about ethics is diferent from instruction about othertopics.

2. Describe common barriers to teaching ethics.

3. Describe important educational objectives for ethics and the teaching strategiesthat facilitate them.

Case

Mary Rivera, 82, was admitted to the hospitalwith shortness of breath, diarrhea,weakness, andnear syncope. She has a history of Alzheimer’s Disease, diabetes, hypertension, chronic aspiration,and multiple episodes of pneumonia. She is again diagnosed with aspiration pneumonia.On admission, she is awake and oriented, requests treatment to “help her breathe” and notesshe has an advance directive on file. Subsequently, her cognition declines. Her kidneys beginto fail and recovery is considered unlikely.

Mary was widowed years before and has seven adult children, all of whom regularly visit herin the hospital. Her youngest son, Jimmy, 43, has continued to live with her since childhood.Jimmy is a large man who previously worked part time as a bouncer at a local night club, butclaims he quit his job to stay home to care for his mother. His demeanor is intimidating and theunit nurses often call security when he visits. He presents an advance directive Mary prepared8 years prior that names him as durable power of attorney (DPOA) and expresses a preferencefor continued treatment. He states Mary had told him repeatedly to fight for her. The advancedirective in the chart is more recent, dated 3 years ago, and names Mary’s eldest daughter, Emily,as DPOA, and states a preference to forgo life-sustaining treatment in the event that her conditionis irreversible and incurable. Emily is a quiet woman, married with four children, and worksas an accountant. Brother and sister have been at odds regarding their mother’s treatment andthe other siblings have taken sides. At medical issue is Mary’s code status and continuation ofventilator support. Socially, the siblings report that Jimmy is living on Mary’s social security andwants to continue treatment to maintain his source of income. Emily believes their mother issuffering and that treatment is contrary to Mary’s wishes.