An elderly man presents himself to the ER. He has contractures and paralysis of his left hand and is aphasic. Upon questioning, he removes his

An elderly man presents himself to the ER. He has contractures and paralysis of his left hand and is aphasic. Upon questioning, he removes his left shoe and points to his big toe. The nurse is unable to gather additional information from him because of his difficulty in communicating. She asks if someone is accompanying him. He shakes his head. The nurse asks him how he came to the hospital. He shows her a driver’s license. Subsequently the nurse leaves the room and returns a few minutes later to find that the patient has left the hospital having received no care. Martha is a 75-year old woman who has terminal cancer of the bladder. During the course of her therapy, she sustains third degree radiation burns to her lower abdomen and pelvic area. Her wounds are extensive and deep involving her abdominal wall, bladder and vagina. The doctor orders frequent medicinal douches and wound irrigation. These treatments are very painful and the patient wants the treatment discontinued but is too timid to actually refuse them. The doctor will not change the order.