The of Mary - Case Study Example

The Case of Mary Introduction The case of Mary is a difficult one because her family is involved. There are several issues that must be confronted. Mary is 35 years old with two children age three and five. Mary is presenting schizophrenia type symptoms that include fear that people are trying to hurt her and her children, extreme agitation, preoccupation with religious thoughts written messages, and that here family is "in league with the devil" (Case study). Marys agitation began after her sister Louise visited recently. Mary eventually went to the hospital under police escort and she was admitted as an "involuntary patient" for assessment. While Mary was in the hospital, her children were taken care of by her family. Louise in particular was taking care of the children although Mary did not want this to happen. There is basically a conflict between Mary and her family. The family wants to take the children and leave Mary in the hospital. Marys mother is manipulating the people around Mary to take her children and keep them away from her. Mary is fighting to keep her family together. Kantian Ethics It is not known from the current case study whether Mary can act rationally on her own. According to Kant, "A person acts morally when decisions are consistent with his or her true rational nature when decisions are consistent with his or her true rational nature and are made free from coercion of others" (Module 1, Kantian Ethics). In Marys case, the clinician would have to understand what Mary wanted and help her find the options to keep her children safe. Mary is acting irrationally on the one hand because she is having hallucinations. However, it is not known how much of her acting out is due to the stress from her family and a need for medication. If the clinician can help her get stabilized, they will then have time to deal with what she wants to do with her children. Marys family seems to be going against Kants motive of duty in that they do not care about Mary and there seems to be something more to the situation than has been expressed so far. Mary is caught up in the emotion of the situation which Kant suggests that here is always a conflict between actions that are good and those that are a means to an end. Mary also seems to be motivated by a sense of duty to her children, which is more important than intent, according to Kent. The clinician would need to make sure that they also were acting from their own sense of duty to Mary. Since Mary must decide the best course for her children, she must not make any decisions until she is stabilized. Marys ability to stay autonomous with her children must also be considered as the clinician remembers to "do no harm" in her behalf. This is in line with Kants idea of taking care of patients and respecting their humanity at the same time, even though they may be incarcerated. Jansen (2000) suggests that there are two ways for a person to look at ethics. On the one hand, they are written in general terms, which means that an individual must decide for themselves how they will behave within the framework of the ethical construct. This also means that in most situations, ethics are applied in a case by case basis. Therefore, what the clinician decides for Mary would be different in a different context. Also, it is important to note that the clinician would have to have a virtuous moral character in order to describe the difference between what was right or wrong for themselves in order to help Mary find her way (Jansen, 2000). Ells (2001) points out that many people act "contrary to their best interest" (p. 420) and this is sometimes due to the fact that everyone is a product of their environment and the people that they live around. In Marys case, it could be that she is acting contrary to her best interest because she desperately wants to keep her children away from her family and this is the only way that she knows how to react to the constant threat. With this in mind, it could be that Mary will be perfectly at peace once she can dissolve the threat of losing her children to her family. Mary and Aristotle If the clinician were working through Aristotles ethics, they would see Marys dilemma from the viewpoint of what would make Mary happy. Mary was fighting for the cause of keeping her children. According to Aristotle, this is a virtue. The clinician would need to practice fairness, friendliness, patience, compassion and tolerance as virtues in this situation. They would need to use patience and tolerance in dealing with the family as the situation was sorted out. Helping Mary to take control of her own life through counseling and perhaps medication would support her acquiring of virtues that she may not currently use. Helping her develop skills and understand her own abilities with her children could help her become ready to hear options for her life with her children. The clinician would also need to help Mary find the strength to make her family leave her alone. This could not happen without the interaction of family therapy to sort out the various issues. The family challenges with alcoholism, the mothers manipulation of everyone and their interaction with Mary would have to be addressed. Ultimately, the clinician again would need to keep focused on "do no harm" while respecting Marys confidentiality. Technically, Mary is 35 and has not been incarcerated, so the family cannot make decisions for her about her children. She may also need assistance to acquire a family lawyer who could help her understand her rights and put something in writing to keep the family away. In this way, Mary can find her virtues, understand her choices and be more prepared to deal with her family. Robertson and Walter (2007) suggest that "the virtuous physician possesses practical wisdom to find the right actions in the specific role of alleviating suffering of the ill". (p. 208). In other words, the clinician working with Mary would need to use a practical wisdom within the situation in order to help Mary design the process that was best for her and to keep her family at bay. In this way, the clinician would be sure that they had acted in a virtuous way in helping Mary keep her children and put her family into perspective. Another area of concern is that of Marys need for medication. There probably will come a time in the very near future that she would need to have some type of medication and it may need to be given to her without her permission at first. Aristotle would argue that making someone take something against their will was unethical and the clinician should instead appeal to Marys need to do what is right for her. According to Armstrong and Barker (1999), if Mary wants to live well, she will need to acquire the virtues necessary to make sure that her life goes well. In this instance, having medication may be important for the virtues of self-reliance, self-discipline and justice. Mary will need to understand what is most important to her life and to living with her children. If the clinician can help her understand the issues that are most important to her, there is a chance that she will acquire the virtues that she needs. Mary and Utilitarian Ethics As a clinician using Utilitarian ethics, the primary objective would be to understand the consequences that had occurred for Mary and how clinician interventions could help. According to Bentham, it would be important to decrease the emotional pain that Mary is experiencing and increase her pleasure which may mean to help her understand her own strength and her options with her children. Bentham also said that in terms of health, the way of measuring consequences in a situation would depend on the impact of a decision on the wellbeing of the affected individuals. In this situation, it would mean that the wellbeing of Mary and her children and her immediate family would have to be taken into consideration when making the decisions about the children and family. IN this case, family therapy would definitely be important to help the family move forward. It would be important for the clinician to decide whether Marys actions pose harm to herself and to her children. This could not necessarily be seen unless Mary is stabilized. There would have to be a full medical and psychological workup to see whether this situation was an ongoing occurrence or because of the stress from her sister. Another area of concern for Mary may be the issue of informed consent. In the even that she needs to undergo treatment, she would need to be told the consequences of this situation and the risks involved so she could make a decision. Nord (2006) studied this issue and found that it was very important for a patient to understand the consequences and trade-offs related to the process they are going to undergo. Also, in using Nords idea, it would seem that the clinician would need to talk to Mary about the consequences of her behavior in terms of keeping her children. As an example, if she were to continue acting out in the ways she has, the courts could decide that she was a danger to herself, her children and other people, which could bring the consequence of losing her children. On the other hand, if she gets herself under control, the consequences could favor her decision to take care of her children on her own. Rowe (2010) also suggests that confidentiality must be looked at through the lens of Utilitarian Ethics. For Mary, it is very important to maintain her confidentiality and not that of the family. As an example, her family is requesting that she not be told about their underhanded dealings. The clinician cannot honor this because Mary is the patient and needs to know what is going on. Rowe (2010) brings back the idea that the clinician should help Mary decide what is good for her and what is not good. This would talk about the goodness or rightness of the situation. For the clinician, this may mean that they must either adhere to the letter of the law or decide what is good for Mary. In this case, keeping her confidentiality is most important to the law and should be important to the clinician. The family would not be taken into consideration here but the children would be a concern. The goodness or rightness for the children would begin first with Marys wishes and her mental and physical ability to take care of the children. If after stabilization she is able to work well with her children, then the case could be determined that the best interest for Mary and her children would be to stay together. Again, the family would not be part of the confidentiality clause because they are not in charge of and do not have Power of Attorney for Mary or her children. The clinician would have to assist Mary in knowing her rights and making sure that she did not sign anything in haste. Conclusion There are many different ways that people will understand how to make ethical decisions. In the end, each individual will have to decide, based on their own morals and training what to do in each situation. The duty for clinicians is always to "do no harm" and to be at the forefront of helping a client understand what their best options are in any situation. In Marys case, the clinician would have to understand this and make sure that they made the best decision as possible for Mary. In each of the ethical theories, there are issues that come up that can be explained by the theory. As an example, it is clear that Mary must find the virtues that are most important to her so that she can move forward out of her personal power and not because of fear. She must also be able to do what is best for herself and known the consequences of these actions. She must also understand that she must stay stabilized with medication if necessary, in order to do the best for her children. References Armstrong, A. and Barker, P. (1999). Commentary. Enforced medication and virtue- ethics. Journal of Psychiatric & Mental Health Nursing, 6 (4), 329-34. Retrieved August 15, 2010 from CINAHL database (AN: 1999067515). Ells, C. (2001). Shifting the autonomy debate to theory as ideology. Journal of Medicine & Philosophy, 26 (4), 417-430. Retrieved August 15, 2010 from Academic Search Premier database (AN: 5486117) Jansen, L.A. (2000). The virtues in their place: Virtue ethics in medicine. Theoretical Medicine, 21 . 261-276. Nord, E. (2006). Utilitarian decision analysis of informed consent. American Journal of Bioethics 6 (3), 65-67. DOI: 10.1080/15265160600686109 Robertson, M., and Walter, G. (2007). Overview of psychiatric ethics II: virtue ethics and the ethics of care. Australasian Psychiatry. 15 (3), 207-211. DOI: 10.1080/10398560701308282 Rowe, J. (2010). Information disclosure to family caregivers: Applying Thirouxs framework. Nursing Ethics, 17 (4), 435-444. DOI: 10.1177/0969733010364892 Read More