Healthcare Ethics: Palliative Care Decisions for Alzheimer's Patients

This report addresses the ethical considerations in the palliative care of an 88-year-old Alzheimer's patient, Mr. Parker, who is experiencing end-stage symptoms, including refusal to eat. The report analyzes the patient's capacity to make decisions, the role of his daughter who is not the primary caregiver, and the ethical implications of healthcare decisions. It explores the importance of patient wishes, advanced directives, and the involvement of healthcare professionals in decision-making. The report emphasizes the need to educate the patient's daughter about palliative care, its benefits, and its distinction from euthanasia, highlighting the role of palliative care in improving the quality of life and managing symptoms. The report also discusses the hospital's ethical responsibility to prioritize the patient's well-being and to involve all family members in the care process, while also respecting the healthcare team's expertise and decisions.

Running head: MEMORANDUM
ALZHEIMER PATIENT PALLATIVE CARE
Name of the Student
Name of the University
Author note

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MEMORANDUM
Mr. Parker is an 88 years old man struggle with end stage of Alzheimer. He is in his
wheelchair and most of the time he sleeps in his wheelchair. He likes to sit near the window
and relax on his wheelchair. His window faces the garden. He gets spoon fed however
suddenly he stopped to eat, he refuses to eat if someone forces him to do it. However, health
care decision made at the end stage of life is a crucial decision that relates to primary ethical
issues bound with Mr. Parker. As per the case of Mr. Parker, he is not in his state of mind to
make a proper decision about his life. His daughter, takes all the decision. However, Parker’s
daughter is not a part of the primary care of the patient hence she does not have the state for
making any decision for the patient’s wellbeing.
Answer a
As Parker is suffering from Alzheimer final stage so it is predicted that he cannot
make his own decision as Alzheimer destroys memory as well as other brain activity. It dries
up the brain cells (Volicer & Simard, 2015). The person undergoes confusion, memory loss
however medication might reduce the symptom nevertheless cannot cure it. So it is difficult
to rely on patient’s decision. However, Parker do not have proper caregiver who can make a
clear decision regarding the care and health matter. The wishes made by Parker along with
his chosen values would be incorporated in the care decision making process. The will of
living and advanced directives need to be checked prior making final decisions. The decision
making does not always work in the way that the patient’s family and the patient have the
sole authority for making the decision. However, health care people also have the right to
take any decision if the matter turns out to be serious (Becker, 2016).
Answer b
The known wishes that is identified till now is he is refusing to eat and sits near the
window with wheelchair facing the ground. When Alzheimer patient stops eating it gives an

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MEMORANDUM
indication that there is a sign of worsening illness such as cold, stomach problem, urinary
infection or constipation. Depression and anxiety is another sign for Alzheimer patient not
eating. Mr. Parker might also have a problem in the place where he is living or the pace
where he is offered with food. It is clearly understandable that he is facing some difficulty
however he cannot express it because of his Alzheimer (Carter et al., 2017). Our
responsibility is to see if the patient himself is having any choices or preferences. However,
in Parker’s case he is unable to make any decision because of his age. He prefers sitting near
the window on wheelchair looking at the garden outside his window. He also refuses to eat.
It can be assumed that as he sits near the window looking at the ground it might be
that he is having some problem with the place and he wants to change the place where he is
living and eating. It can also be another reason that we know that Parker, is having three
children, and only one daughter is involved in medical treatment; it might be that he wants to
see his other two children. He wants to feel comfortable with all his children around.
However, as hospital authority you have seen that only one daughter is involved in his care, it
would be better to inform his daughter to ask his other two children to visit. This would
further help us noticing if there is any change in his health.
As per the medical and nursing guidelines patient choices are always given first
priority and hence his choice is the priority for the hospital people. The hospital authority as
well as DON (Director of Nursing) must listen to it. The choice and demands made by Parker
are legitimate and hence can be fulfilled.
Answer c
Parker’s daughter is not involved in the primary care of the patient hence she is not
the substitute for making decision. She can discuss with the health professional about her
thoughts and ideas regarding the decision made by the authority however prevent the

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MEMORANDUM
authority. As it is clear from her conversation that she donot understand the meaning of
palliative care and the decision made by the authority depends on the choices and wishes
made by her father.
She cannot make healthcare authority to comply to her decision. She has a primitive
knowledge about the palliative care and the suffering of his father. Hence, she cannot comply
heath authority to comply her choices. As health personnel we know that patient’s decision
do matters however in this the patient is 88 years old man incapable to making any decision
for himself.
On other hand, it is the duty of the healthcare people to make the daughter understand about
the decision, her father disease, suffering and choices as well as about palliative care benefits.
It is necessary that the health care people must explain patient’s family as well as
patient. We as a health care people must explain Parker’s daughter about palliative care, and
the way it will help him to improve from the present state of mind and health situations. We
need to make her understand, palliative care does not mean killing a patient. Discussion about
palliative care related to the positive and negative impact must be told clearly to the patient
and his daughter (Cross, 2019).
Parker’s daughter must know the detail about the Alzheimer that her father is going
through. The health care people must tell her that palliative care, does not mean killing
nonetheless it is a means of treatment done to provide relief and prevention through early
identification and immaculate assessment as well as treatment for pain in addition other
problems (Mills, Wand & Fraser, 2017). So, this scenario hospital authority has the right to
decide depending on the patient’s present state.

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MEMORANDUM
The daughter must be explained that if the same situation continues her father
condition would deteriorate faster and he would proceed towards death. Hence, the decision
that is made by hospital authority are correct.
First and foremost, daughter must be told that the main objective of palliative care is
to enhance the quality of life of the patient (Kelley & Morrison, 2015). Palliative care is
provided to the patient at any level. Daughter’s protest regarding showed that she does not
have any information about palliative care and being a DON (Director of Nursing) it is
necessary for you and your team to explain her about it.
It is health care people responsibility to tell Mr. Parker’s daughter that palliative care
is provided by doctors, nurse and all health professional under proper guidance of knowledge
and medical equipment’s (Durepos et al. 2017). Palliative care is a treatment plan that can
help family to care an individual in home in an assisted living facility as well as in nursing
home (Jethwa & Onalaja, 2015). As it has been observed Mr. Parker is having difficulty in
eating the palliative care would help him to cope causing improvement in feeding difficulty,
hospitalization, feeling of depression and the proper place where to be cared for (van Deijck
et al., 2016)
Daughter’s support to the treatment would add extra support towards comforting the
patient. As it has been noticed that Mr. Parker is sitting in wheelchair all day near his window
looking into the garden. It can be assumed that he is having any kind of depression and on
other side he also stopped eating, that would make the situation worse if the situation
continues. The palliative care would help in treating the symptoms for Alzheimer. It would
also help in learning the ways to avoid different behavioral syndrome (Nakanishi et al.,
2015). Parker’s daughter must be explained that important techniques performed in palliative
care for Alzheimer patient is memory as well as physical therapy. This would help in the

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MEMORANDUM
brain developmental process for her father. He would be provided with quiet and calm
environment; which cannot be provided at present. He would be provided with proper lights
to decrease shadow effects.
However, it must be made clear to the daughter that she cannot be involved in the
primary care policy. She cannot make decision regarding Mr. Parker. I know as per nursing
principle we must abide by patient’s choices and listen to family’s demand. However, the
demand made my Parker’s daughter is irrevalant. Hence, it must not be taken into
consideration. It is clear that you do not have to follow her preferences and must prefer the
decision that is taken by DON and the health team. As a DON, you can explain Parker’s
daughter that there have been many case of Alzheimer and their positive outcomes. You can
explain that palliative care can bring a great difference towards family caregivers.
Hence, I would suggest it would be better to explain all the positive outcomes of
palliative care and explain the daughter that palliative care does not means killing the person
however providing him the facilities that are good for his development. Palliative care is an
intensive care. She must be assured that the hospital authority provides proper care to his
father and try make him feel comfortable and would improve in his feeding habit. As Mr.
Parker is 88 years old and this age is very crucial. So an intensive care is required to reduce
his pain and suffering. The daughter also be told that palliative care is a healthcare recognized
method performed in various parts of USA and in the world to improve patient’s suffering.
Therefore, it can be concluded from the paper that DON must discuss in detail about
the present state of Mr. Parker to his daughter and explain about the disease Alzheimer that
he going through and its impact if not treated properly. DON must also elaborate about
palliative care to the daughter and ensure that there is nothing to get scared about it.

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