Welcome to Ethics Consult — an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true patient care case. You vote on your decision in the case and, next week, we’ll reveal how you all made the call. Bioethicist Jacob M. Appel, MD, JD, will also weigh in with an ethical framework to help you learn and prepare.
The following case is adapted from Appel’s 2019 book, Who Says You’re Dead? Medical & Ethical Dilemmas for the Curious & Concerned:
Riley and Norma are two elderly residents of the dementia unit at the Shady Acres Nursing Home. Both suffer from Alzheimer’s disease and are profoundly impaired — generally unable to recognize friends and family or to accomplish more than the most basic tasks. In addition, Norma has numerous outbursts daily, likely tied to anxiety and paranoia. Both of their spouses are deceased; their children live in distant states, check in infrequently, and never visit.
One week, the staff at Shady Acres notice a profound change in Norma. She is calmer and less paranoid. Six days elapse without an outburst. The staff soon discovers a possible cause: Riley has been sneaking into Norma’s room each night after lights-out, and the couple has been engaging in sexual intercourse. It appears Riley is mistaking Norma for his late wife. Although neither Riley nor Norma have the capacity to consent to sex in the way of people without cognitive impairment, they both seem to find the experience soothing and therapeutic.
Jacob M. Appel, MD, JD, is director of ethics education in psychiatry and a member of the institutional review board at the Icahn School of Medicine at Mount Sinai in New York City. He holds an MD from Columbia University, a JD from Harvard Law School, and a bioethics MA from Albany Medical College.
And check out some of our past Ethics Consult cases:
Is This Doctor Being Asked to Support Torture?
Report Alleged Improper Doctor-Patient Relationship?
Refuse Treatment for Dictator?
Source: MedicalNewsToday.com
