An 87yearold woman, Ms. V, was diagnosed with stage 4 Breast Cancer and consented to 6 months of aggressive
chemotherapy treatment. During the first three months of treatment, Ms. V began to experience weekly hospitalizations as
a result of chemotherapy side effects. Eventually blood transfusions and iron treatments were required. Ms. V thereafter
began to experience edema, breathing difficulties, and cardiac heart failure.
The attending oncologist did not completely disclose prognosis to Ms. V and her family. Throughout the treatment process
did not clearly address the quality of life for Ms. V. Shortly after four weeks’ the chemotherapy treatment was suspended
because the harsh side effects deathly weakened Ms.V. She became incontinent, lost physical strength and was limited in
In order to administer additional chemotherapy treatments, the oncologist stated the Ms. V would need cardiologist
consent to continue the aggressive treatment phase. Consent would not be given until additional cardiac exams were
Ms. V had not seen a cardiologist in years and felt reluctant in meeting with someone who did not know her medical
history. The appointment was scheduled and Ms. V was seen by the cardiologist, who determined she was, in fact, too
weak to continue chemotherapy treatment and discovered an aneurism in her aorta. Ms. V would continue to be
monitored by the cardiologist until it was determined she could resume aggressive chemotherapy treatment.
Ms. V lived with her older 47 year old son, Mr. T, who was divorced with two grown children. They had a strained
relationship for many years, yet Ms. V, for many years, provided a home, financial support by paying annual property
taxes, electric, water, and phone bills. Mr. T wanted to be supportive of his mother, but became extremely irritated as Ms.
V’s illness progressed and she required more attention and assistance. Due to the inability to effectively communicate
with each other, Mr. T became distant and less attentive to his mother’s daily needs. Ms. V began to feel isolated and
struggled with accepting her current situation. She wondered if she had been an unsupportive mother.
During an appointment with the cardiologist, Ms. V mentioned that she was not eating, sleeping, and able to bathe herself
well. The cardiologist sensed that neglect was occurring, since her medication regimen was not being followed as needed,
her weight dropped significantly and she appeared disheveled during the last three appointments. This assessment
prompted a call to APS and the family was under investigation.
Mr. T stated during the investigation that he never had a close relationship with his mother compared to his siblings and
often felt he was treated “differently and unfair”. Now that his mother was ill, he did not want the caregiving responsibility.
Mostly, Mr. T felt this way because he did not how to physically care for his mother. He wanted the other two siblings to
assist in the responsibility in taking their mother to doctor appointments, treatments, and attending to her needs during the
week. Mr. T felt he did not have the support of his siblings. They often had excuses about why they could not help.
The six propositions have a focus on gender, language, socioeconomic status, and geographic considerations. However, a potential flaw within the propositions is not considering ethnicity. Student ethnicity is not considered within the study nor the impacts of ethnic background on students choosing a HEI. This is a potential limitation when considering student choice of HEIs in the United States, specially the historically black colleges including Howard University, Spelman College, and Hapmton University. Since these schools do not have large endowments in comparison to large prestigious HEIs such as Harvard University, with an endowment of 36 billion dollars (Mulvey, J., and Holen, M., 2016), they cannot offer as much financial aid. Therefore, many students decide to attend a different HEI which can offer a more attractive financial aid package, but at the cost of sacrificing the opportunity of being part of a unparalleled cultural experience at a historically black college (Gasman, M., 2009). In the United States, endowments are the universities’ largest financial asset and serves a major determinant in student choice in HEIs. This study would benefit by having a comparative approach to HEIs in the United States if time and word limit permitted. A further point of tension within the study is the ambiguity of terms. Firstly, two out of the six propositions (ie. propositions two and six) did not provide a description which puts into question the validity of the study. Furthermore, the phrase “not entering HE” occurred nine times throughout the study. The researchers did not specify in any of those sentences what it means by “not entering HE.” An important question to ask is whether “not entering HE” refers to students taking a gap year and eventually returning to higher education or entering the labour market and never pursuing HE. This is a significant distinction because if students are taking a gap year but will return to HE it shows that they are impacted by the economy and having financial stability is an important consideration for them before starting their studies. There are no statistics in the study to outline the percentage of students not pursuing HE and no words to explain their decision. These are important considerations to help build depth within the study. The epistemological assumptions of this study help us to understand student choice of HEIs by hypothesizing and testing empirical approaches through a natural science lens. On the other hand, the ontological assumption concerns the natural world, taking in account the effects of the global financial crisis in 2008, and the human behavior within the global HE context (Pring 2005, p. 232). Wilkins, Shams, and Husiman embrace quantitative methods approach to the study, using SPSS software to generalize the findings and test the propositions. Since the data is in a numeric form, statistical tests are applied in making statements about the data. Quantitative studies help to produce data that is descriptive but difficulties arise when it comes to their interpretation. For instance, it is helpful that the study includes the demographics and socioeconomic statuses of the participants, but the study would have more depth if it integrated a qualitative approach in addition to the quantitative research. The students had a one hour discussion on the questionnaire yet there is no student voice, only statistics from SPSS. With group discussion responses we can have a qualitative measure of analysis of the data caption. Without properly interpreting the data behind these numbers, it is difficult to say why students choose HEIs based on financial considerations. In conclusion, the rise of tuition fees in England has altered the ways in which students choose to enter HE and if so, which HEIs. Wilkins, Shams, and Husiman mention that this study is not intended for policy reform (p. 137); however, it calls attention to the pressures placed on students in determining to enter HEIs and brings awareness to the major factors of student choice. An important consideration for restructuring this study is incorporating a mixed methods approach, by utilizing qualitative and quantitative methods. Without the necessary qualitative data, there is no authentic way to determine why students are choosing a certain HEI. If Wilkins, Shams, and Husiman used an interpretive paradigm and observations from the discussion groups to investigate the issues on the increase tuition fees it would create a more holistic picture of the student experience and behaviors with statistical data to prove the point. Lastly, the data used in this study was gathered before the increase in fees in 2012 (Wilkins, Shams, & Husiman, 2013, p. 129). Students were aware of the fee increase but it was not a real determining factor for them at that point in time. It would be most helpful to have a follow-up study at the same colleges from which the data for this study was collected, using the questionnaires, and group discussion in order to compare and contrast student opinions and choice patterns overtime. >GET ANSWER