Case study : An 83-year-old diabetic male, Mr. Jones, is brought in to the emergency department because of respiratory distress by his care-giving daughter, with whom he lives.
Assignment: Principle of nonmaleficence

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An 83-year-old diabetic male, Mr. Jones, is brought in to the emergency department because of respiratory distress by his care-giving daughter, with whom he lives. In examining him, the emergency department physician discovers that Mr. Jones has gangrene on his right foot up to his ankle. Mr. Jones’ daughter reports that her father has been diagnosed with Alzheimer’s disease. A preliminary capacity assessment is consistent with mild dementia but one of the nurses suggests that Mr. Jones’ confusion might be the result of his respiratory distress, coupled with the disorienting atmosphere of the emergency department. The clinical recommendation is to perform a below-the-knee amputation. The patient refuses this surgery, saying he has lived long enough and wants to die with his body intact.

Does the father have autonomy to make this decision? Why or why not? Discuss the principle of nonmaleficence as it relates to actions of the providers. (1–2 pages)

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1
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Sub-Competency 1: Analyze medical ethical issues and legal concepts.
Learning Objective 1.6:
Define the principles of respect for autonomy and nonmaleficence.

Definitions of the principles of respect for autonomy and nonmaleficence are missing. Response provides partial or inaccurate definitions of the principles of respect for autonomy and nonmaleficence. Response provides thorough and accurate definitions of the principles of respect for autonomy and nonmaleficence. Response demonstrates the same level of achievement as “2,” plus the following:
Response uses one or more examples to demonstrate an understanding of how the principles of respect for autonomy and nonmaleficence can conflict.

Learning Objective 1.7:
Explain the prioritization of respect for autonomy and nonmaleficence.

Explanation of how to choose which principle to prioritize is missing. Response provides a partial or unclear explanation of which principle to prioritize or fails to provide support for reasoning about which principle to prioritize.
Response provides an irrelevant example of information the hospital would use to determine whether to prioritize respect for autonomy or nonmaleficence.

Response clearly explains which principle to prioritize when patients refuse care
Response provides at least one relevant example of information the hospital would use to determine whether to prioritize respect for autonomy or nonmaleficence.

Response demonstrates the same level of achievement as “2,” plus the following:
Response identifies other principles or philosophies that could guide decisions about how to prioritize principles of respect for autonomy and nonmaleficence.

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