A 57-year-old man who was diagnosed with motor neuron disease 2 years ago is experiencing a rapid decline in his condition. He prefers to be admitted to the in-patient unit at a hospice to receive end-of-life care, but his wife wants him to remain at home.

Answer:

In this scenario, it would be necessary to know if advance directives are in place for the patient. The focus of the visit should be on the current symptoms of the decline. Social history would be imperative to gather to gain insight of the current home situation and the needs of the patient. By gathering this information, the provider can strive to ensure that the patient and wife have a mutual understanding of the patient’s condition and prognosis.

As a provider, it would be best to speak with the patient alone, to discuss his wishes on whether he prefers an in-patient hospice unit or to be cared for at home. I would discuss the different services that could be provided in each place to ensure he understands both options. Also, involving a hospice or palliative care representative might helpful to the patient and wife discuss their options. The patient-provider relationship is fiduciary, and the provider is obligated to abide by the patient’s wishes and if he wants to keep this confidential; therefore, patient’s autonomy and wishes will be respected. Respecting the patient’s autonomy when knowing that they have full decision-making capabilities is ethical (Sedig, 2016).