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from Part III - Diversity of Desires and Limits of Liberty
Published online by Cambridge University Press: 17 May 2025
In this chapter of Complex Ethics Consultations: Cases that Haunt Us, the authors describe a 24-year-old patient with C-3 spinal cord injury resulting in quadriplegia and ventilator dependence. He is admitted from a nursing home with multiple serious pressure ulcers. No family or friends who offered him support and companionship. With full decision-making capacity, he declined turning and dressing changes for up to a week. His ulcers were worse and a foul odor emitted from his hospital room. He wanted to live, not risk dying though his choices were doing just that. The ethics consultant negotiated a "Ulysses contract," stipulating that dressing changes and turning would occur once a day and his objections would not be honored. The patient agreed. The authors reflect on the ethical, professional, and haunting conundrum that arose due to this contract.
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