Ethical Dilemmas Cases  

This particular ethical dilemma case mentioned below involves whether or not to continue attending to a patient who required occupational therapy services, and continue to give the patient medical care even though the patient is breaking the guidelines set by Medicare, but at the same time the criteria set by Medicare for homebound patients is quite unclear.

Ms EH is a woman, who is eighty-six years old. She is under ‘home health’, after she ran out of days for allowed skilled nursing facility provided by Medicare. Owing to financial problems, she opted to live in her trailer home, and was showing considerable progress with the services of the home health. One night her husband Mr. RH ended up getting a myocardial infarction and had to be hospitalized, and later shifted to a nursing home. Ms EH was, obviously, concerned and visited her husband every day for hours at the nursing home, leaving her with no energy to keep up with her own home health appointment. Now the guidelines for patients under home health care provided by Medicare clearly states that the patients must meet certain "homebound" criteria, like being unable to leave their homes, or if they do, it should infrequently, or for very short durations.

The ethical issues raised by this case are quite a few. First is autonomy, or the patient's right to get the treatment at home, and the healthcare professional’s autonomy to take a call on whether she should get the same. Next is the doctor’s professional obligation to divulge correct information on the patient's inability to adhere to criterion of being homebound. Third is the issue of fidelity on the part of the healthcare professional to those who are involved in this matter -- the patient, the doctor and the insurers.

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