Events

Case:
Bethany is a 15 yo who presented to the hospital in diabetic ketoacidosis five weeks ago. Prior to her admission, she ran away from her cousin’s house, leaving behind her diabetic medications. She is medically stable and ready for discharge, but her cousin has refused to come pick her up. Her cousin does not feel she can keep Bethany safe and no other relatives are not willing to provide her care.

Her mother was 16 years old and in foster care when Bethany was born.  Though she wanted to parent, Bethany’s mother struggled with her own mental health and substance use issues. Bethany’s mother would often leave her for extended periods with various relatives. Her mother was recently incarcerated. Bethany’s father is not involved in her life.

Bethany has experienced transient living conditions, domestic violence, and community violence throughout her life. She has suffered inappropriate sexual touching from several family friends. Some caregivers have used physical punishment that resulted in injury.

Bethany has struggled in school, with difficulty staying focused and difficulty learning reading and math skills. She gets frustrated easily, leading to outbursts that can include verbal threats, property destruction, and occasional physical aggression. She often stays out all night without permission. She has left home for over a week on three different occasions.

She was recently diagnosed with insulin dependent diabetes mellitus. Since then, she has struggled to monitor her medication. When calm and feeling supported, she can test her glucose and administer her insulin appropriately. When frustrated or stressed, however, she makes poor food choices and does not monitor her medication appropriately. This is the second time she has left home for several days without her medication.

When her cousin refused to have Bethany return to her care, hospital staff called Child Protective Services. The plan is to find her a placement, and then bring her into foster care. No placement has yet been found that is willing to take a youth with diabetes with a recent history of running away.

Bethany has been ready for discharge for over four weeks. While she was initially pleasant and cooperative, she has grown restless and bored. She has had repeated outbursts with cursing and threats toward staff. On one occasion, she threw her dinner tray at a nurse. Last week she threatened to punch a nurse who told her she would need to wait a few minutes before a requested item could be delivered.

Questions for consideration:

• What are the ethical issues?
• Who are the stakeholders?  Are there tensions between stakeholders?
• What about this case could lead to moral distress?