Question

This is a theoretical case taken from VHA Intensive Ethics Advisory Committee Training, 1998, as presented by Arthur R. Derse MD, JD. An 87-year-old woman widowed for six years, who is otherwise healthy, was visiting another city and abruptly became ill. She was seen in the emergency department of the local VA and admitted to the on-call physician. The on-call physician (who has not previously seen her) made the diagnosis of bowel obstruction arid made arrangements for a surgeon to evaluate her. The surgeon recommended surgery and obtained her consent for surgery. The surgeon expects an uneventful recovery. She is told that she will be on a ventilator for a short time after surgery. The patient tells the surgeon that is OK as long as it is for a short time. She tells the surgeon that she does not want to be dependent upon machines. She was asked upon admission whether she had an advance directive. She replied that she has a living will and a power of attorney for health care which names her daughter (who does not live in the area) as her health care agent. The patient undergoes surgery, which is successful in treating the underlying problem and does not show any malignant causes, but in the recovery room she has a cardiopulmonary arrest and is resuscitated. She is transferred to the ICU in the care of the on-call physician. The physician attempts to wean her gradually from the ventilator, but this is unsuccessful. Three days later, she has regained consciousness but is still intubated. Though she cannot speak because of the ventilator, she is able to write and asks that the tube be removed. The attending physician tells her that she is dependent upon the ventilator and the patient needs to remain on the ventilator until she can breathe on her own. She writes that she understands that she may die, but she does not want to be on machines. Her only children -- a daughter and son -- - have arrived. She repeats her wish to them that she wants the tube removed. She writes to her daughter that "I don't want to die, but we all have to die sometime, and I don't want to have to live on a machine. I know that whatever the outcome, God will take care of me." Her daughter tells the physician that her mother is adamant that she be off of machines and she respects her mother's wishes, even if she cannot breathe on her own. She says this is consistent with her previously expressed wishes and her religious beliefs. Her son tells the physician that he disagrees with his sister -- since his mother does not have a terminal condition, he can not see why she should not be forced to put up with the ventilator until she can be weaned from it. He feels that she is being shortsighted, and she will be thankful to have been kept on the ventilator when she is finally able to be weaned. Describe the criteria for giving "legal" consent. Were all elements met in this case? In other words, did the patient demonstrate decision-making capacity? Explain. (Minimum of 1 page including in-text citations and references in proper APA format)

Answer 1

1.The patient self determination Act is a law that indicates clients must be provided with information about their rights to be identify written directions about the care that they wish to recieve in the event that they become incapacitated and are unable to make health care decisions.If the client has an advance directive it must be documented and included in the medical record.There are two basic types of advance directives they are living wills and durable powers of attorney..Living will lists the medical treatment that aclient chooses to omit or refuse if the client becomes unable to make decisions and is terminally ill.Durable powers of attorney appoints a person ie health care proxy chosen by the client to make health care decisions on the clients behalf when the client can no longer make decisions.The Do not Resuscitate (DNR) is an order written by a physician when a client has indicated a desire to be allowed to die if the client suffers cardiac or respiratory arrest.The client or her legal representative must provide informed consent for the DNR status.it must be defined clearly so that other treatment ,not refused by the client ,will be continued.if a client does not have a DNR every effort should be taken to revive the patient.

2.No, The women named her daughter as the health care proxy, as the power of attorney of the clients living will .So whatever decision which is made by her daughter is to be followed by the health care personnel.Her wish of DNR is not carried out ,as the son has conflicting opinions.But as per the advance directives the wish of the dying women ,having a health care proxy ,their decison wil be final and has to be carried out by the health care tea without further questioning

References-Cherry,B.,&Jacob,S.(2008).Contemporary nursing issues:Trends andManagement(4th ed.,pp.176-177) St .Louis:Mosby.

Tomey,A.(2009).Guide to nursing management and leadership(8th ed.,p.497).St.Louis:Mosby.