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Ws. Maria is an 89 year-old latin woman who was diagnosed with vaginal cancer at the beginning some years ago. She is also HIV positive. The cancer had proliferated quite quickly in the setting of a compromised immune system, Ms. Maria engaged in care. The doctors recommend a dose of radiation and chemotherapy, when it was in Stage 4. However, during this time Ms Maria was struggling with substance use. In the hospital, she tested positive for some substances, including cocaine and heroin. As a result, care providers discussed about pain management and which pain medication could be given to her. She was not on methadone treatment maintenance at first, so she was self medication relief her pain. Ms Maria wanted to seek help for her addiction, traditional models were not appropriate given the magnitude of her physical issues. There were expectations that she would get into outpatient treatment but she did not follow through, because it was difficult for her to tolerate being in groups for long periods. Doctors were able to provide Ms Maria with transportation and cab vouchers so she could access the full course of radiation that doctors had recommended. Her pain was not controlled, because her physician refused to prescribe her any pain medication, due of her substance use. the hospital gave her Percocet while she was there but would not give her anything that could not be directly supervised. After treatment, doctors sent her home with prescriptions for Tylenol and instructions to return and follow up with pain management teams, which she was unable to do because of her difficulties with transportation and sitting. Ms Maria completed radiation and is in a period of holding to assess effectiveness of the initial course of radiation, but she still does not have a prescription for her pain, and continues to use substances to manage her pain. Ms  Michael observes, “I have been able to see how managing withdrawal and managing substance abuse in the context of a homelessness. Ms. Maria does not fit very neatly into any mainstream treatment model”.    1. What ethical arguments can you make base on the case study?

 
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