Tubbs, James B. PhD
James B. Tubbs, PhD, is a Professor of Ethics and Religion, Department of Religious Studies, University of Detroit Mercy, Detroit, Michigan.
The author declares no conflicts of interest.
Address for correspondence: James B. Tubbs, PhD, University of Detroit Mercy, 4001 W. McNichols Rd., Detroit, MI 48221 (firstname.lastname@example.org).
Q: The supplemental nutrition program for seniors, Meals on Wheels, is in demand in my area with a long waiting list. One of my patients receives Meals on Wheels, but when I am there, he feeds it to his dog. I hesitate to say anything because the dog provides much-needed companionship to an elderly man without family in the area. However, there are many needy seniors on the waiting list who could really use the program the way it was intended. Should I say or do anything?
This case reflects a potential or perceived tension among several important moral principles and commitments: beneficence, reflected in Meals on Wheels's efforts to meet this elderly man's nutritional needs and the nurse's efforts to meet his health needs; justice, reflected in the nurse's concerns about his nonconsumption of the food provided to him when other homebound seniors also need meal delivery; and individual autonomy, as expressed in his freedom to advance his own sense of well-being by using the food provided to him in whatever way will maximize that which he most values.
Moral reflection on this case requires careful consideration of this man's circumstances and his actual intent in sharing his meals with his dog. What other sources of nourishment are available to him, and what sources are available for feeding his dog? And what is he really trying to express in feeding the dog meals that were delivered for his own consumption?
In one scenario, this gentleman may have access to other sources of nourishing food and is really not fond of the Meals on Wheels cuisine. So, he may be feeding the meals to his dog because that seems less wasteful than simply throwing them away. In that case, it would seem appropriate for the nurse to explain to him the great need others have for the meals he does not want and encourage him to at least suspend his requests for Meals on Wheels deliveries.
In another, similar scenario, he may have access to other sources of nutrition but is accepting the Meals on Wheels deliveries as a matter of convenience, and he is feeding the meals to his dog because the dog enjoys human meals more than dog food. In that case, it would seem reasonable to gently explain to him that this food is intended for human consumption because so many humans are in need of it, and then perhaps offer to shop for some dog food the dog might enjoy.
However, a rather different scenario is also possible. Perhaps the man really does need the delivered food for his own nourishment, but shares it with the dog because of his devotion to the dog and his deep concern for the dog's welfare. This may be his way of honoring the one he considers his best friend by sharing what he considers the “best” that he has. If he were sharing the food with another human being who meant the world to him, few would question his motives or the appropriateness (or justice) of his actions, even though beneficence would lead us to be concerned about his ongoing nutritional status. If he is literally giving the dog the much-needed food off his own plate because of his devotion to the dog, then it seems fair to say that he is choosing to do what is most spiritually and personally nourishing to him even if it does not benefit his body. If that is the case, then it may be most beneficent and most respectful of his autonomy to offer to help him locate another source of food he would consider worthy for his dog so that both might eat reasonably well.
In any case, it would not seem appropriate for the nurse to report this situation to the Meals on Wheels providers unless she or he becomes convinced that the man also interprets his own actions as deliberately “throwing away” nutritious food because he does not need or want it. And even then the patient should be encouraged to disclose that information to Meals on Wheels himself. Justice, beneficence, and respect for autonomy would all seem to require that we make no assumption that he is “wasting” food from Meals on Wheels until we can discern what he most truly needs, what he most deeply values, and what he finds most essential to his well-being.
Definitions of Ethical Principles
Beneficence: Doing good or acting to provide benefit for others.
Justice: Allocation of rights, responsibilities, and resources based on standards of fairness or equity.
Autonomy: Respect for another's self-determination in thought and action.
Inpatient Hospital Deductible and Hospital and Extended Care: Services Coinsurance Amounts for 2014
This notice announces the inpatient hospital deductible and the hospital and extended care services coinsurance amounts for services furnished in calendar year (CY) 2014 under Medicare's Hospital Insurance Program (Medicare Part A). The Medicare statute specifies the formulae used to determine these amounts. For CY 2014, the inpatient hospital deductible will be $1,216. The daily coinsurance amounts for CY 2014 will be: $304 for the 61st through 90th day of hospitalization in a benefit period; $608 for lifetime reserve days; and $152 for the 21st through 100th day of extended care services in a skilled nursing facility in a benefit period.
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