Question

Sally Jones, a 82 year old, black female is admitted in the hospital with multiple strokes. She doesn't recognize or respond to nursing staff, physicians, or family members. Mrs. Jones has extremely poor heart function and is in congestive failure. The doctor in charge of the case contacted the family to discuss her condition and the type of care he should provide her. He also states " there is no more we can do". Her son understands the condition and agrees with DNR (do not resuscitate) order, but the daughter refuses and insists of continuing with the treatment. Based on the information, please answer the following questions:

1. Can the doctor decide to withdraw care without the consent of the family?

2. Have any principles of ethical decision making been violated in this case? Explain your response.

Answer 1

Ans) Futility of Treatment: When the physician recognizes further treatment will be of no benefit to the patient.

- Morally the physician has a duty to inform the patient when there is little likelihood of success of further treatment.

- Determination to futility of medical care is a medical decision based on scientific evidence.

• Do-Not-Resuscitate (DNR) are physician orders not to resuscitate a patient in the event of a cardiac or respiratory arrest

DNR's are:

- Generally written as the result of a patient wishes or at the family's request.
- Orders must be written form, signed and dated by the physician

So, Doctor must fully explain the patient's condition and inform them that now is the time that nothing more can be done & if the family members still refuse then the doctor cannot decide to withdraw care without the consent of family & he can still give them time to think about this till then he needs to continue the treatment.

2) Principles of ethical decision are not violated in this case as:

These are 6-step process for thoughtful and responsible decision.

• Establish the facts in a situation- Doctor called the family members for explaining the patient's condition & about the treatment response.
• Decide whether the situation involves legal or ethical issues- As the treatment will no more benefit the patient so consent of family will be required.
• Identify your options and possible consequences: Determining the need of consent
• Evaluate your options: Without the family consent, Doctor cannot discontinue the treatment
• Choose the best option- Explain the family members about Patient condition & still give them time to think for the consent.
• Implement your decision- Though the famolf as yet not given free wish consent to discontinue the treatment so till the doctor hasn't withdrawn the treatment

So in this case there is no violation of ethical principles.