Year: 2014
Type: article
Abstract: McGuire lives at home with his only child, Jennifer.He is 75, has severe rheumatoid arthritis and a history of atrial fibrillation, for which he takes anticoagulation medication.He can no longer drive and, given his severe arthritis, is dependent on his daughter for his instrumental activities of daily living (IADLs), things like grocery shopping, paying bills, and managing medications, and some of his basic activities of daily living (ADLs), things like bathing, dressing, and walking.Jennifer has been his primary caregiver for two years and has had to cut back on her work hours and significantly decrease social outings.Jennifer accompanies her dad on a visit to Dr. Peterson, his primary care doctor.As is Dr. Peterson's standard policy, he initially interviews Mr. McGuire alone.Knowing his patient's living situation and ever-increasing needs, Dr. Peterson raises the issue of respite care, as he has before.Mr. McGuire reaffirms his absolute opposition to the idea of leaving his home or having others come to help, even as a temporary measure, despite a long discussion about the potential long-term benefits of such an approach.He also asks Dr. Peterson not to even discuss this with Jennifer.After the initial interview, Dr. Peterson invites Jennifer into the exam room and continues with his interview and exam.As he probes deeper, he realizes that Jennifer is more tired than ever and perhaps depressed.Dr. Peterson strongly believes that, if Jennifer doesn't get some relief, she may be unable to take care of her dad in the longer term.Forgoing respite care for Jennifer, he believes, could result in Mr. McGuire's placement in a long-term care facility, which is definitely not what Mr. McGuire desires.Commentary 1 by David Barnard, PhD, JD On the surface this case raises ethical questions of confidentiality (Dr.Peterson believes it is important to have an open discussion with daughter Jennifer about the growing burdens of Mr. McGuire's caregiving needs, but Mr. McGuire has forbidden him to raise the issue with her), and paternalism (Dr.Peterson believes it is in Mr.McGuire's own long-term best interest to override his refusal to consider additional home care services that would lessen the burden on Jennifer).Underlying both of these issues, however, is a deeper question: How should health professionals view the interests and concerns of their patients' family members who bear the burdens of long-term care for patients with serious illness or disability?
Source: The AMA Journal of Ethic
Author: David Barnard
Institution: Oregon Health & Science University
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W54775939