Case Study:

Non-Maleficence vs. Autonomy

Mang Kanor is 64 years old. He has been very healthy by report and very active working
as a dairy farmer. He had a stroke affecting his right side 2 weeks ago and currently has a
moderate leg weakness with a more significant arm weakness, slurred speech, and mild
dysphagia (swallowing difficulty). He is predicted to be ambulatory with a cane, though
prognosis of arm function returning is more guarded. It is likely he will improve speech
function and swallowing ability but will require some specialization of diet to prevent
aspiration.

Mang Kanor has chosen to stop eating, stating that he does not want to live as an invalid.
His family is very distressed and wants him to be forced to eat. They cannot imagine why
he has made this choice when his prognosis is so good compared to others, they have
seen in the rehabilitation setting with much more severe deficits. He has been evaluated
for depression and an antidepressant has been recommended, which he refuses to take
along with all other medications recommended for his newly diagnosed cardiovascular
disease. Mang Kanor is oriented and has not had competence questioned prior to taking
this stand.

Some of the staff supports his decision and others do not. Discussion with the family
reveals that Mang Kanor has frequently made deriding remarks about persons with
disability, including remarks like “If I ever end up that way, just take me out behind the
barn and shoot me.” The psychologist comments that Mang Kanor is frankly depressed
and that part of this depression is related to the location of his stroke. He also points out
that he feels strongly that should the depression be resolved, Mang Kanor would likely
change his opinion.