After reviewing the ‘Ethics Case Presentation of Anna, I found that the major ethical principles

violated in Anna’s case were nonmalificence and fidelity. From the very beginning, Anna sought
comfort measures, or “palliative care,” which her surrogate decision makers, Lance and Ken,
agreed to as well. She had a poor prognosis, which was the reason why home care and hospice
were the best options for her. She was clearly deteriorating. Most importantly, one of the Anna’s
stated goals and preferences was to stay at home and not be hospitalized.

However, on 8/16/11, Anna was transferred to B&WH at her son’s insistence so that more tests
would be performed. The physicians at the other facility deemed the tests as “unnecessary,” but
Lance, acting on his own accord, really wanted to push forward with the transfer. The transfer
was carried out–despite Anna’s wishes– simply because he was one of the surrogate decision
makers. In this scenario, the “unnecessary tests” that were carried out at B&WH would do more
harm to the Anna because she would not benefit from the procedures – as the end’s result would
be futile. She had a poor prognosis to begin with. Hence, the ethical principle of nonmalificence
was violated. Procedures were carried out in which made no difference to Anna’s prognosis. In
contribution to this statement, the breach of fidelity also came into play when Anna’s wishes
were not respected. As mentioned earlier, Anna’s wishes was to stay home and not be
hospitalized. Nevertheless, she had subsequent hospitalizations in the year of 2011 for various
reasons other than palliative care. Due to this, Anna’s suffering was drawn-out.

To put it frankly, Lance was not acting in his mother’s interest, especially having her moved to
many different facilities. I think situations like this could have been avoided had Anna signed an
advance directive or some form of legal documentation that stated she was DNR/DNI and
wanted comfort measures only. Even if Lance was her surrogate decision maker, an advance
directive would have governed over Lance’s decision to have “everything done” when it came to
his mother’s care.