What is the Psychoanalytic theory of consumer decision making process?

Is the patient's autonomy being respected; is she adequately involved in the decision-making process?

• An eighty-five-year-old widow has been in a long-term care facility for six months. She was admitted with severe bone pain. Her family placed her in the facility because she was overmedicating herself at home, confusing her medications, and not eating adequately. She has been a “complainer” for years, the family reports. The family and physician are reluctant to give her strong pain medicines; they don’t want her to be “doped up” like she was at home. She currently takes two Tylenol every four hours which does not adequately control her pain (and risks liver and kidney damage). She is in too much pain to walk, but quickly becomes uncomfortable in the wheelchair. So she requests bed rest and frequent repositioning. Staff feels she is demanding and hard to please. She has a son who calls and tries to visit once a week, but who becomes tired of hearing her constant complaints of pain. Her daughter lives out of town, and calls weekly. The son asks the doctor to make her more comfortable and satisfy her complaints. But the son also requests that the doctor not give her the medication she received six months ago (at the time of admission) which caused her to drool and be unable to sit up or eat. Her sister has called the state regulatory agency to complain that the facility staff is neglecting her and not taking care of her pain. The doctor agrees to try a risky anti-inflammatory drug to ease her pain. After two weeks, she has dark, tarry stools, suddenly vomits blood, and is hospitalized for a severe stomach bleed. • How could a meeting of all parties involved have been more effective and/or ethical than piecemeal decision making? • Since the doctor sees the resident only every two months, should he be the primary person to assess and monitor the pain and its treatment? Who else should be involved? • What ethical theory or principle can function as a basis for good pain management? • Who should be held responsible for the woman’s complications and hospitalization? • What other issues do you think this case raises?

• Answer:

  Hi, The head nurse is the one that reports to the doctors. So she is. Pain management is the most difficult to do. Every drug has side effects. Some take a long time to kick in and others are too strong. Everyone is different. There is no straight answer.