Case Study: Benefit or Burden: How Much Is Too Much? Doris Boswell is a 78-year-old female with Alzheimer’s disease, rhe

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Case Study: Benefit or Burden: How Much Is Too Much?
Doris Boswell is a 78-year-old female with Alzheimer’s disease, rheumatoid arthritis, and type II diabetes mellitus. For the last seven years she has resided at Comfort Rest Nursing Home, but for years before her admittance to the nursing home she lived with her son and his wife. Caring for her became so difficult that her son, John, and his wife could not safely keep her at home any longer. Her son visits every week or as often as possible.
Two years ago, Ms. Boswell developed end-stage renal disease and progressive per­ipheral neuropathy because of the advancement of her diabetes mellitus. Over time, her dementia has worsened noticeably, but her quality of life remained surprisingly good, despite the presence of her chronic diseases, and her dependence on nursing assistants for feeding and activities of daily living. Although she does not talk, she sometimes cries out in pain.
In the last few months, Ms. Boswell’s behavior has changed. She is becoming more irritable by the day and is displaying behavior outbursts when the nurses or anyone else attempt to move her or do anything with her that is not a part of her ordinary daily care. The dialysis treatments have become too burdensome to manage because of her emotional outbursts and resistance.
After a thorough work-up, there was no physical reason for this drastic change in her behavior, so her physician attributed the change to the progression of Alzheimer’s disease. Dr. Phillips, her primary physician and medical director of the nursing home, believes that the dialysis is more of a burden than a benefit for Ms. Boswell. Dr. Phillips believes that since he regards Ms. Boswell’s quality of life as poor, dialysis treatments are a waste of valuable resources. Without dialysis, Dr. Phillips believes that Ms. Boswell would only live for a month or so. John and the physician discussed the benefit-burden issue, the treatment options, and the outcomes and prognosis of discontinuing dialysis. John was adamant that he wanted his mother to live as long as she could on dialysis, so he told Dr. Phillips that the nursing home administration did not need to worry about money and resources. John informed Dr. Phillips that he would be responsible for the bill and that he had plenty of money. He told Dr. Phillips that his mother would want to live as long as possible.
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