This OSP Journal of Case Reports section is a vignette almanac whose purpose is to provide a record of the emotional climates of the general practitioner, expressed as metaphors of landscapes, geographical features, atmospheric data, lunar phases, sunrises and sunsets, beginning and end of the seasons of the year, winds, tides, etc., when dealing with different clinical cases, with the aim of achieving a greater understanding of what we are and what we do as doctors, and then achieving greater empathy. Here, a vignette of a case of an elderly patient with no close family, and the appearance of a sudden interest from distant relatives in taking care of her, respectively devaluing the interest of the other party, is presented. This situation creates an emotional climate in the doctor that suggests the patient seems to be a swamp, with a very muddy bottom, with mud, silt, stones, roots and other buried remains, as well as underwater currents of water… This poses a significant danger of becoming trapped.
Emotions; Caregivers; End-of-life care; Ethics; Family; Metaphor; General practitioner
Euphrasia is 82 years old. She lives alone. She has no immediate family, except for a niece. Euphrasia suffers from dementia with behavioral changes; she does not want her niece to come to her house “because she steals things from her.” A few months ago, the niece and her husband told general practitioner (GP) that niece went to her house from time to time to take care of her… but now Euphrasia does not want to see her.
Now, Euphrasia’s niece, accompanied by her husband, come to the doctor’s office. They had never been there before; the doctor had only occasionally spoken to them on the phone.
-“Doctor, it’s about Euphrasia… you know… she’s alone, she argues with the neighbors, she doesn’t want to let us into her house… we’re afraid something might happen to her… So we thought you should give us a report on her mental state for the Judge… But if we have to report her so the Judge can intervene, then we won’t do anything…; we don’t want to report her. It is so that the judge decides to take her to a nursing home…”
The very next day, David comes to the office:
-”It is the first time I see you, David…”, says the doctor.
-”It is not for my, doctor…, it is for Euphrasia. I am a distant relative, and my wife and I are worried about her situation… You know, with dementia and living alone… Sometimes we go to visit her in case she needs something… And now, what I want to ask you is a report to request financial help for home care…”
-”Do you know that your nephews also try to help you…?”, asks the doctor.
-”Well…, it is not that we get along badly…, but we do not have much of a relationship… Besides, Euphrasia does not want them to take care of her. Why are you asking me about them, Doctor?”
-”Well, because they were here just yesterday…”
-”Hummm…, yeah… And can you tell me what they wanted, doctor?”
-”Help you…”, answers the doctor.
Euphrasia is an “orphaned older adult”; an older person with no immediate relatives to help her cope with physical and mental health problems.
During the last period of life, many older people and their families are faced with decisions that challenge ethical principles and can cause conflicts between family members as well as with health professionals. The commonly used ethical principles of autonomy, beneficence, non-maleficence and justice, although they form a useful basis for assessing decision-making dilemmas, cannot alone resolve many clinically challenging situations [1, 2].
When several people share the responsibility of caring for an older person, family conflicts may arise. It is good for several people to care for an older person, although they will not always have the same point of view [3], and disputes occur when some family members perceive that others dominate the care and property of the parents, and who separate the older person to prevent them from participating in decisions about care and property [4].
Involuntary commitment or involuntary admission is a legal process by which a person with a mental disorder is admitted to a facility without his or her consent to receive treatment. In order for the commitment to take place, an administrative legal process must be initiated that will require judicial authorization [5]. Likewise, when the person with dementia can no longer express his or her will, judicial support measures must be initiated to protect his or her financial and legal interests [6].
The doctor thinks that when it is a nephew or distant relative who cares for or rarely visits the elderly person, and suddenly takes an intense interest in him or her, it is intuited that there are possible situations of abuse of the elderly and problems with inheritance [7], and thus one is entering a swampy area.
Euphrasia suggests to the doctor a "bog"; a stagnant and shallow body of water in which aquatic vegetation grows, sometimes very dense. Euphrasia is a wet, spongy, poorly drained vegetated area containing a high percentage of organic remnants and residues, frequently associated with a subsurface water source [8]. A swamp, with a very muddy bottom, with mud, silt, stones, roots and other buried remains, as well as underwater currents of water… This poses a significant danger of becoming trapped.
- Gordon M (2002) Ethical challenges in end-of-life therapies in the elderly. Drugs Aging 19: 321-329. [Crossref]
- Ullrich A., Theochari M., Bergelt C (2020) Ethical challenges in family caregivers of patients with advanced cancer – a qualitative study. BMC Palliat Care 19: 70. [Crossref]
- Institució Ibars (2024) Family conflicts over the care of elderly people: how to mediate.
- Lashewicz B, Keating N (2009) Tensions among siblings in parent care. Eur J Ageing 6: 127-135. [Crossref]
- Salus Play (2024) Topic 3. Ethical conflicts in the care of the elderly.
- British Geriatrics Society (2020) End of Life Care in Frailty: Law and ethics. Clinical Guidelines.
- Prades J (2010) Dependency eats up the inheritance. Disability Information Service. Servicio de Información sobre Discapacidad –Facultad de Psicología –Universidad de Salamanca.
- The Coastal Wiki (2024) Definitions of coastal terms.
