Case 1
It is hard to imagine that the city of New Orleans could have been less prepared for what happened in the aftermath of Hurricane Katrina. But the unfolding horror went well beyond the Superdome and people stranded without water and food on overpasses, as even those who were prepared were overwhelmed by the event. John was employed as a staff nurse in a major 300-bed tertiary care facility in New Orleans during Katrina. The hospital had an emergency plan to assure adequate staffing during hurricanes. Essentially the plan created a three-level nursing response team. The nurses assigned to level 1 and 2 were considered the first responders and were expected to report to the hospital 8 hours before the arrival of a storm and remain for 12 hours after its departure.
During this time the hospital would be in lockdown where no employees were allowed to leave or enter the facility regardless of their shift assignments. Once the lockdown phase was ended, nurses assigned to level 3 would take over and provide relief for levels 1 and 2.
John did not accept a level 1 or 2 position that would have designated him among the first responders. This was because his wife was an insulin-dependent diabetic who was on a strict dietary, medication, and exercise regime. John had, however, assumed the role of a level 3 responder and, during previous trial exercises, had reported as a level 3 relief nurse.
Unsure of where the approaching hurricane would make landfall, John and his wife prepared to evacuate the city to wait out the storm. It is then that he got a call from a friend, a fellow nurse, who was assigned as level 2 personnel, requesting he drop by his friend’s apartment and bring him some necessary medications and toiletries he had forgotten to bring with him to the hospital. John agreed and picked up the requested items, planning to drop them off as he left the city.
However, when John arrived at the hospital, everything had changed. More than half of those who had been designated as level 1 and 2 responders had not come to the hospital and instead had joined the mass exodus fleeing the city. The nursing administrator pled with John to stay in the hospital to assist with the care of the patients; he was assured his wife would be appropriately lodged and that her medical and dietary needs would be cared for.
John and his wife joined the several thousand staff, family members, and pets that were sheltering in the hospital. Ten hours post-Katrina, the situation deteriorated to the point where essential electricity, food, and water had to be rationed. There was no hope of assistance from other level 3 personnel as all roads into the city were closed.
Completing a shift, John faced a crisis as his wife’s blood sugars were out of control and they could no longer rely on the food (dietary needs) or medication supply at the hospital. He contacted the nursing supervisor to tell her he had decided to take his wife from the hospital and try to get out of the city. The nursing supervisor assured him that they would do everything possible to take care of his wife and ordered him to remain at his post. She also informed him that should he leave, it would constitute job abandonment, and she would report his actions to the Louisiana State Board of Nursing.
Think of this problem in light of the Ethics of Care:

If you were John, would you stay or leave? Explain your decision.
List all the ethically sound options that John might consider.
Do you think the nursing supervisor’s decision was correct?
If John leaves, should he receive a reprimand for his action? Potentially lose his license? Explain your answer.
Regardless of whether John receives a reprimand, what should be done about the level 1 and 2 nurses who failed to come to the hospital to assume their roles?

Case 2
Mr. Jimenez is a 78-year-old chronic pulmonary disease patient (emphysema) who has smoked two packs a day for 40 years. He takes great enjoyment and satisfaction in smoking and does not want to quit.
In that his illness is exacerbated by smoking, his physician is demanding that he quit. Each time he tries to quit smoking, Mr. Jimenez becomes irritable and unhappy. His wife and family hate it when he is not smoking because he becomes difficult to live with.

Consider this case from the position of act utilitarianism and create a pleasure-gained and pain-avoided list to see if you can determine whether Mr. Jimenez should continue or quit smoking.