The Case of the Depressed Patient

Ellennor F. Abrigo, Althea Mariell Mantua, Monique Olaivar, & Justine Felice Ursabia,
AHSE II

Time Context: May, 2004

Viewpoint: Tayabas Community Hospital

BACKGROUND

At 80, R. L. lives with his wife in a retirement community and has

always valued his independence, but recently he is having difficulty walking
and managing his medications for diabetes, heart disease and kidney
problems. His doctor diagnoses depression after noting that R. L. has lost in
the things he used to enjoy. Lethargic and sleepless, R. L. has difficulty
maintaining his weight and talks about killing himself with a loaded gun so
he is prescribed to try medication for the mood disorder.

Two weeks later, before the effect of the medication can be seen, R. L.
is hospitalized for a heart attack. The heart is damaged so severely it can’t
pump enough blood to keep the kidneys working. Renal dialysis is necessary
to keep R. L. alive.

After the second treatment, R. L. demands that the dialysis be stopped

and asks to be allowed to die.

1.0 Definition of Terms

1. Renal dialysis – involves moving the patient three times a week to

the dialysis unit, where needles are inserted into a large artery and
a vein to connect him to a machine for three to four hours
2. Depression – a mood disorder that can profoundly affect a person’s
ability to think positively, experience pleasure or imagine a brighter
future
3. Informed consent – a process wherein a patient agree to undergo or
refuse a medical treatment

ANALYSIS PROPER

1.0 Problem

When R. L. asks to discontinue his life-sustaining treatment,

depression may be impairing his ability to make decisions. In this case
 study, the physician toggles a common dilemma of whether R. L.’s
refusal of dialysis represented an authentic exercise of his right to stop
life-saving treatment or a convenient means to passively end his life.

2.0 Objectives

2.1 To determine whether the patient’s decision is being affected by

his mood disorder
2.2 To give the most appropriate course of action considering the
patient’s ability to make decision
2.3 To respect the client’s decision if his decision making ability is
not impaired by depression
2.4 To maintain a good harmonious relationship with the client

3.0 Areas of Consideration

3.1 R. L. is 80 years old.

3.2 R. L. has always valued his independence in a retirement
community.
3.3 He is having difficulty managing his heart disease, diabetes and
kidney problems.
3.4 R. L. is diagnosed with a mood disorder that the depressed
patient may have difficulty concentrating or may be troubled by
feelings of guilt and hopelessness.
3.5 Preoccupation with death is common and in R. L.’s case his
condition includes being suicidal.
3.6 He is hospitalized for a heart attack just before the effect of
mood disorder medication can be seen.
3.7 R.L. asks to withhold the dialysis but the physician suspects that
the patient’s capacity for autonomous decision making is
impaired by depression.

4.0 Alternative Courses of Action

Alternative Course of Action One:

Justification:

Alternative Course of Action Two:

Justification:

Alternative Course of Action Three:

Justification:
5.0 Recommendation

It is recommended that Alternative Course of Action No. 3 be

pursued to see if depression has truly affected R.L.’s capacity of
making a legitimate life-and-death decision.

6.0 Plan of Action

R.L. should bear the burden of the renal dialysis until the anti-
depressant medication would begin to take effect.

7.0 Potential Problem

7.1 The medication is also refused too soon before the effects of the
medication could be seen.
7.2 R.L. might commit suicide.
7.3 R.L. might try to physically stop the renal dialysis and run away
from the procedure.
7.4 If R.L. survived to discharge, he would probably need nursing
home care, a fate he had resisted even before his depression.

8.0 Contingent Plan of Action

Have R.L. monitored in a room and oblige to administer each

medication of the disorder and procedures of the renal dialysis.