A 72-year-old woman on your caseload has been in mental health services for a number of years, ever since the year after she graduated from college. She has had severe episodes of schizophrenia over the years with countless hospitalizations and prescriptions for numerous antipsychotics and antidepressants. All her life she has been a client of social services and hotlines, reaching out frequently for any support she could get. She has always been very dependent on her case managers, calling them often for support. When support was withdrawn, as it often was when workers tried to get her to be more independent, the woman would deteriorate. 

Sometime after she turned 60, these severe, acute episodes diminished, and she has been living in comfortable subsidized living arrangements for senior citizens. As she has grown older she has developed breathing problems that will eventually take her life. In an effort to be helpful and without your knowledge, her family doctor referred her to hospice for support. In his view she was facing the end of her life. Hospice entered the picture with considerable support, seeing her often, providing meals and companionship. This level of attention met the woman’s needs for support and she became extremely dependent on the hospice workers. She seemed happier and began to participate more in the group activities at the apartment building where she lived. This level of support is more than you could give and you have been relieved that she is doing so well with the hospice workers. However, hospice has decided to withdraw their services. The woman’s death does not appear to be imminent. In fact she appears to be improving slightly. The woman has called you, her case manager, in a complete panic at the prospect of losing this support. She is not eating and is distraught. What are the ramifications here? 

What does continued hospice support mean for hospice, which relies on public and charitable funding? What are the consequences if the services are withdrawn for this woman and for you? Are there solutions to this problem? Are there ethical considerations here? 

Sit with a small group of other students and decide how you will handle each situation. There are many areas both ethically and legally that are not clear, so the discussion you have with your colleagues about these cases is much like a discussion you might have in a real agency. There are no “correct answers.”