skarletstarlet Posted December 31, 2011 Report Share Posted December 31, 2011 Hey guys I saw this on an out of province school's website. This is a situation that may arise on CASPer that I am struggling with. The scenario is that you are volunteering in a homeless shelter. You come across an alcoholic woman who is in her last days of life, and she expresses to you that her last wish is to "die happy" (drunk). The shelter doesn't allow alcohol on the premises. What do you do? Well at first glance I thought maybe I'd find out if she had any relatives (since the scenario doesn't say either way). If she did, I could call and explain the situation and ask if they'd help fulfil her last wishes. The key issue here is that she is able to express her last wish. We sort of have a duty to try and accommodate her. Is it really causing more harm than good? Alcohol is about to put her in an early grave already... Then again, alcohol is what has led her to her imminent death. Bah. Thoughts? Link to comment Share on other sites More sharing options...
thehumanmacbook Posted December 31, 2011 Report Share Posted December 31, 2011 There's no right or wrong answer to this. Use your judgement and knowledge to explore both (or many) sides of the issue, then perhaps indicate why you and your cumulative experiences would lean towards one particular course of action. Link to comment Share on other sites More sharing options...
skarletstarlet Posted December 31, 2011 Author Report Share Posted December 31, 2011 Personally, I feel like if it were a Friday I'd ask her to Crabby Joes for $4 martinis! But all joking aside, even though alcohol has led her to an early grave, she has a right to her last wish. It isn't going to help extend her life by any means, but it isn't going to lead to a worse outcome than she is already facing. Why not allow the woman to die happy? The question is, do I pull her out of the facility and take her for drinks or take her back to my place? Is that even allowed? Do I contact a family member and delegate the responsibility? I wish the scenario would mention consequences I may face for signing her out of the shelter. Link to comment Share on other sites More sharing options...
thehumanmacbook Posted December 31, 2011 Report Share Posted December 31, 2011 ^well, CASPer is also looking for ethical reasoning as well. As a volunteer, do you have the right/authority to be making that EOL decision? It also looks at your decision making process. Although it does not explicitly state the consequences, you can highlight what you think may happen and whether you're ready to accept them to ensure this woman's last wishes. You also have a time limit. Be conscious of what you will write. Link to comment Share on other sites More sharing options...
jojoluvsu2 Posted December 31, 2011 Report Share Posted December 31, 2011 My first thought wasn't so much about the ethics of providing alcohol to a woman dying of alcohol use. Frequently in the hospital family members will bring in a drink for someone in the ICU who is unable to get one for themselves, of course not to excess. I read about a palliative care facility who administered beer into an NG tube of a dying patient, as one of his last requests. If smoking weren't a safety issue for other patients (and didn't gross me out) I would have no issue with someone dying of lung cancer having a cigarette. If someone who is more able bodied has that right, why not the dying? (Sorry for the mini-rant, I just had this debate with someone so I'm a little hyped up ) How I would approach that question is that there are two parties you have to be concerned of: fulfilling a dying woman's wish and the shelter's right to have their rules respected (ie. no alcohol on the premise). I would mention that I would first and foremost respect the shelter's rules and would not bring alcohol onto the premise without their explicit permission. Doing so would compromise their authority over the other shelter guests and could lead to more problems. Then maybe say how you would contact family, social workers or other people who might have the authority to take the woman out of the shelter. Express your desire to see that the woman is made happy in her last days, and a collaborative decision amongst various employees may be the best decision. You want to protect yourself as well, you don't want any liability on your head, so bringing them to your house would be a bad idea. And say all this (or what you decide is right for you) in 5 VERY SHORT minutes Link to comment Share on other sites More sharing options...
skarletstarlet Posted December 31, 2011 Author Report Share Posted December 31, 2011 ^well, CASPer is also looking for ethical reasoning as well. As a volunteer, do you have the right/authority to be making that EOL decision? It also looks at your decision making process. Although it does not explicitly state the consequences, you can highlight what you think may happen and whether you're ready to accept them to ensure this woman's last wishes. You also have a time limit. Be conscious of what you will write. I never considered the status of being simply a 'volunteer.' Thanks for putting that into perspective! Link to comment Share on other sites More sharing options...
skarletstarlet Posted December 31, 2011 Author Report Share Posted December 31, 2011 My first thought wasn't so much about the ethics of providing alcohol to a woman dying of alcohol use. Frequently in the hospital family members will bring in a drink for someone in the ICU who is unable to get one for themselves, of course not to excess. I read about a palliative care facility who administered beer into an NG tube of a dying patient, as one of his last requests. If smoking weren't a safety issue for other patients (and didn't gross me out) I would have no issue with someone dying of lung cancer having a cigarette. If someone who is more able bodied has that right, why not the dying? (Sorry for the mini-rant, I just had this debate with someone so I'm a little hyped up ) How I would approach that question is that there are two parties you have to be concerned of: fulfilling a dying woman's wish and the shelter's right to have their rules respected (ie. no alcohol on the premise). I would mention that I would first and foremost respect the shelter's rules and would not bring alcohol onto the premise without their explicit permission. Doing so would compromise their authority over the other shelter guests and could lead to more problems. Then maybe say how you would contact family, social workers or other people who might have the authority to take the woman out of the shelter. Express your desire to see that the woman is made happy in her last days, and a collaborative decision amongst various employees may be the best decision. You want to protect yourself as well, you don't want any liability on your head, so bringing them to your house would be a bad idea. And say all this (or what you decide is right for you) in 5 VERY SHORT minutes I think that holding a staff meeting is a great idea. Hopefully they are as empathetic as I am about the issue. Great response!! Thanks Link to comment Share on other sites More sharing options...
HopeToBeGreen Posted December 31, 2011 Report Share Posted December 31, 2011 The thing that jumps out at me is that she wants to die drunk not just get drunk one more time before she dies. If you read it that way the question is really about whether you will help her to attempt suicide. I wouldn't. You could conclude that just helping her get drunk one more time is a good compromise. Deep down in my gut I just don't want to help her with that either though. Part of my discomfort comes from my own experience with alcoholics. I've seen how much damage alcohol does and I don't want to be part of enabling that, even at the end of someone's life. It offends my ethics and so I wouldn't get involved. When I see a scenario like this I often try to think through lots of different variants of the problem to try and identify what the important principles are for me. I thought I'd share some of the variants I came up with in hopes they would help you figure out your own feelings: The woman is not dying, she just wants to get drunk. (Are last wishes somehow different from other wishes?) The woman is dying but she wants get high on heroin not alcohol. (Are you willing to break the law instead of just the shelter rules to grant her wish?) Instead of a woman it is a man. (Often people feel less sympathetic toward men) The man is dying but instead of wanting to get drunk he wants to go off, watch pornographic videos and pleasure himself. Pornography is not allowed in the shelter. (The man wants something socially unacceptable (like alcohol) but it will not do him any physical harm.) The woman wants to eat a really nice (expensive) meal in a good restaurant before she dies. (Is there a limit to generosity?) Link to comment Share on other sites More sharing options...
skarletstarlet Posted December 31, 2011 Author Report Share Posted December 31, 2011 The thing that jumps out at me is that she wants to die drunk not just get drunk one more time before she dies. If you read it that way the question is really about whether you will help her to attempt suicide. I wouldn't. You could conclude that just helping her get drunk one more time is a good compromise. Deep down in my gut I just don't want to help her with that either though. Part of my discomfort comes from my own experience with alcoholics. I've seen how much damage alcohol does and I don't want to be part of enabling that, even at the end of someone's life. It offends my ethics and so I wouldn't get involved. When I see a scenario like this I often try to think through lots of different variants of the problem to try and identify what the important principles are for me. I thought I'd share some of the variants I came up with in hopes they would help you figure out your own feelings: The woman is not dying, she just wants to get drunk. (Are last wishes somehow different from other wishes?) The woman is dying but she wants get high on heroin not alcohol. (Are you willing to break the law instead of just the shelter rules to grant her wish?) Instead of a woman it is a man. (Often people feel less sympathetic toward men) The man is dying but instead of wanting to get drunk he wants to go off, watch pornographic videos and pleasure himself. Pornography is not allowed in the shelter. (The man wants something socially unacceptable (like alcohol) but it will not do him any physical harm.) The woman wants to eat a really nice (expensive) meal in a good restaurant before she dies. (Is there a limit to generosity?) I too have a history with alcoholics that makes it very difficult for me... Alcohol issues run on both sides of my family and I grew up witnessing many things children shouldn't see their family (extended and not so extended) do. I appreciate the list. Changing the scenario ever so slightly does help put things into perspective. Link to comment Share on other sites More sharing options...
funnyboy6 Posted January 3, 2012 Report Share Posted January 3, 2012 Interesting ethical scenario. I feel the conflict comes down to respecting somebody's wishes vs. institutional practices (in this case, not having alcohol on the premise). I sympathize with the notion that in her last days, we should try to accommodate her wishes. As others have pointed out, it is not unusual for healthcare workers to go out of their way to meet some strange patient demands (e.g., beer via feeding tube). However, there are two opposing issues. First, as a volunteer, the homeless shelter is giving you the privilege to volunteer there. You have an obligation to adhere to their rules. Second, there is the slippery slope argument. Where do we draw the line? Will giving this person alcohol compel others to demand that they have alcohol in the shelter? I would try to take a balanced approach: could we find someone outside of the shelter who could provide shelter and meet this person's wishes? A friend, social worker, family, etc? Further, I would discuss this with the management of the shelter, or those who make the rules for the shelter and discuss a solution. Now, if I had to make a decision one way or the other, I would not provide this person with alcohol. While I understand and sympathize with her dilemma, I have strict rules to adhere to (as a volunteer). This scenario, much like certain situations in medicine, is very difficult because you are tied down by the rules you have promised to adhere to. My decision is largely based on personal experience as a hospital worker and volunteer. But I don't blame anybody for acting differently. Link to comment Share on other sites More sharing options...
skier87 Posted January 4, 2012 Report Share Posted January 4, 2012 I actually just came across this question today! How I see it is that there are two options: allow her to have the alcohol, or don't allow her to have it and instead try another form of palliative support such as empathic conversation. Option 1: -woman dies happy that her last wish was granted, gains closure -volunteer might ruin relationship with shelter because they broke the rule of no alcohol and might not be able to come back and volunteer there in the future -downing a whole bottle of vodka might cause more harm for the woman than good Option 2: -no alcohol given: woman is not satisfied -volunteer maintains their trusting relationship with the shelter -some other form of support (ie. just sitting with her, providing company and empathy) might be just as helpful as giving her alcohol -no liability issues with volunteer breaking the rules Alternatives could be to ask the shelter workers if they have come across this situation in the past and if they have ever "looked the other way" in order to fulfill a person's dying wish. Or if there is the possibility of a social worker/family helping out the woman - but as another poster mentioned, as a volunteer you have pretty strict guidelines as to what you can/can't do in this type of situation. Link to comment Share on other sites More sharing options...
GLAB Posted January 4, 2012 Report Share Posted January 4, 2012 Just a perspective on this question. HopeToBeGreen almost touched on it with his first variant on the problem "What if the woman wasn't dying, and just wanted to get drunk?". No one seems to have addressed the question of whether or not the woman is actually dying, the original scenario doesn't indicate that you're in any way qualified to make that assessment, for all you know she's just telling you she's about ready to die to get a drink. That may sound like I don't have a lot of faith in humanity but coming from Vancouver, which has a whole lot of homeless people, if you walk up Hastings street enough times you're pretty much guaranteed to hear that excuse or worse from people looking for you to buy them a drink, or drugs. If thats all the information contained in the question you should address the fact that for all you know it's not her "last wish" at all. People with addiction problems can go to great lengths to get what they need, alcohol is no different. Link to comment Share on other sites More sharing options...
skarletstarlet Posted January 20, 2012 Author Report Share Posted January 20, 2012 Wow! The responses kept coming while I was away. Way to go! I really appreciate everyone's different viewpoints. Bouncing these situations off of my UG buddies does not produce the same kind of ideas Link to comment Share on other sites More sharing options...
Tee88 Posted January 22, 2012 Report Share Posted January 22, 2012 Just to add to the perspectives listed... what also hasn't been taken into account is if she "thinks" she is dying when really she may be suffering from withdrawal (which has the potential to be worse), instead as a volunteer at this shelter I think it's important to be informed of this woman's background/history and really important to empathize with her wishes, however, how many other individuals would you be willing to break the rules for? And to what extent? Ahhhh I understand the points of view where "maybe she just wants a drink" ..as in she is pulling the wool over your eyes, I realize that's a possibility but I don't necessarily think that's something evidence based especially from that short scenario. Especially, if you haven't communicated with her to understand what/where she is coming from. Many external circumstances have brought her to the situation she is in (who knows it could be abuse/addictions etc.) and to believe that she is just scamming you seems to be a frequent failure in our medical system, as many individuals fall through the cracks of getting the help they need <-- from experience, I volunteer at a crisis centre with female sex-trade workers and the majority of them will refuse to go to the emerge if they have abscesses or have been raped, simply because when they ask/need help, they feel judged by the practitioners because of who they are and what they do ... by the way some people have responded, I can now see that loss of objectivity given the word "alcoholic"... because if this woman, who is an alcoholic, is asking for a drink <-- the alcoholism clearly has deeper seeded issues that you as a volunteer cannot completely address but it is important to recognize, it may just be her way of asking you to ease her pains and this is her cry for help; you should consider your resources as a volunteer, while asking yourself WHY she is feeling the way she is. Link to comment Share on other sites More sharing options...
skarletstarlet Posted January 25, 2012 Author Report Share Posted January 25, 2012 Just to add to the perspectives listed... what also hasn't been taken into account is if she "thinks" she is dying when really she may be suffering from withdrawal (which has the potential to be worse), instead as a volunteer at this shelter I think it's important to be informed of this woman's background/history and really important to empathize with her wishes, however, how many other individuals would you be willing to break the rules for? And to what extent? Ahhhh I understand the points of view where "maybe she just wants a drink" ..as in she is pulling the wool over your eyes, I realize that's a possibility but I don't necessarily think that's something evidence based especially from that short scenario. Especially, if you haven't communicated with her to understand what/where she is coming from. Many external circumstances have brought her to the situation she is in (who knows it could be abuse/addictions etc.) and to believe that she is just scamming you seems to be a frequent failure in our medical system, as many individuals fall through the cracks of getting the help they need <-- from experience, I volunteer at a crisis centre with female sex-trade workers and the majority of them will refuse to go to the emerge if they have abscesses or have been raped, simply because when they ask/need help, they feel judged by the practitioners because of who they are and what they do ... by the way some people have responded, I can now see that loss of objectivity given the word "alcoholic"... because if this woman, who is an alcoholic, is asking for a drink <-- the alcoholism clearly has deeper seeded issues that you as a volunteer cannot completely address but it is important to recognize, it may just be her way of asking you to ease her pains and this is her cry for help; you should consider your resources as a volunteer, while asking yourself WHY she is feeling the way she is. Sorry Tee, should have been more clear. Apparently in the situation it is quite well established that she is in fact dying. She has yellowing of the skin and other signs that her organs are beginning to shut down. I can't remember how it was worded but it did mention she has 48 hours at most or something. I took a course on women and aging - mostly we discussed the judgments women feel are passed upon them for seeking help from our health care system so I am right there with you. I am very interested in your volunteer work. Kudos to you! So far, I've canvassed for big organizations and been a mentor to 'troubled' kids in school. How did you get into volunteering in that area? I am from a small town North of Toronto so that kind of volunteerism is not readily available. Its great that your experience can help you form an opinion though. I guess I have to get out there and volunteer more Link to comment Share on other sites More sharing options...
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