Question

A forty-five-year-old man with a three-year history of cardiovascular disease has entered the hospital with a stroke that has paralyzed his right side and caused him to aspirate food of any consistency. His mental status is clouded and there is disagreement as to whether or not he has decisional capacity. His language capacity is only “yes” and “no,” and his responses are inconsistent. The attending physician is convinced that the patient has lost decisional capacity while two family members are equally convinced that he has decisional capacity. The patient’s wife and two other children are ambivalent about his competency to make decisions. The prognosis for recovery of safe swallowing and speech approaches zero because of the dense damage to the cerebral cortex visible on brain imaging. Two neurological consultants have verified that recovery is likely to be minimal and that permanent, severe disability will be the outcome.

The patient does not have an advance directive. The patient’s wife says that they never did discuss his preferences about life-sustaining treatment. She is convinced that he would not want to live in this disabled condition, but is uncertain whether to request the placement of a feeding tube. Two of her four adult children are strongly opposed to the tube placement, while the other two insist that not to do so would be to “kill our father.” The patient’s wife is torn between these two positions, but finally requests that the tube be placed.

The attending physician and the rest of the treatment team are opposed to placing the feeding tube. Their argument is that the patient has “minimal consciousness” and will not improve. They define this as a futile situation with no reasonable expectation of recovery. Furthermore, two nurses claim that during previous hospitalizations for episodes of cardiovascular events the patient told them that he would not want to be sustained by artificial means — not by ventilators, renal dialysis, or tube feeding. It is their position that the patient has expressed his preference to not be kept alive in a futile situation.

The family requests an ethics consultation.

1. The family is divided over whether or not their husband/father should be placed on a feeding tube.

If the husband is deemed competent, who makes the final decision? _________

If not competent, who is the husbands’ official surrogate? ___________

The burdens the treatment (feeding tube) imposes should not be a consideration for the adult children? True_________ False _________

Ethics committees play an advisory role? True _______ False______

Ethics committees act as advocates for the healthcare team? True______ False ________

Decisions of ethics committee are legally binding? True____ False____

Please briefly answer/discuss the following:

The judgment of futility should be a conclusion of a communications process, not a beginning. How would you propose beginning the communication process with the family in this case?

First consider, what is the purpose of an ethics committee?

What information should be shared?

Who should be present?

What alternatives are on the table in this case?

Should the nurses’ statements be considered?

As part of the healthcare team, what is your goal in participating in the discussion?

Answer 1

If the husband is deemed competent, who makes the final decision? The patient / Wife

If not competent, who is the husbands’ official surrogate? Wife

The burdens the treatment (feeding tube) imposes should not be a consideration for the adult children?    True

Ethics committees play an advisory role? True

Ethics committees act as advocates for the healthcare team? False

Decisions of ethics committee are legally binding? False

The judgment of futility should be a conclusion of a communications process, not a beginning. How would you propose beginning the communication process with the family in this case?

Treatment request of the family of the patient and psychological influence on patient side due to the management were somewhat strained. The core subject is difference amid healthcare professionals and patients about providing or preceding futile managements. The status of communication and cooperation by mutually flanks should be highlighted.

First consider, what is the purpose of an ethics committee?

There are two significant requirements positioned on the ethics committee. Initially, and greatest prominently, the ethics committee must safeguard that the privileges of investigation members are secure. Furthermore, the investigation ethics committee has a responsibility to people which delivers the capitals for investigation and will eventually be pretentious by the consequences.

What information should be shared? Who should be present?

The absolute gauge and difficulty of these connections within the healthcare scheme puts a heavy weight on the procedure of announcement, and miscommunication can have dreadful values. In this case study, the info must be shared with the wife as she is the sole decision maker being the spouse of the patient. The children can be present if the wife wishes to.

What alternatives are on the table in this case?

The patient can be supported through artificial life support and may improve is one alternative. Second one is that patient’s previous wishes if documented that no artificial support is preferred by him can be followed as patient’s consent is very much important in cases where he can make decisions if in correct state of mind.

Should the nurses’ statements be considered?

The nurse’s statement can be considered if there is signed documentation from patient’s end.

As part of the healthcare team, what is your goal in participating in the discussion?

In health care, patient confidentiality apprehensions brand it significant that illegal persons do not admittance clinical records. To defend privacy, communications can be jumbled or ‘encoded’ as a means to avert illegal individuals interrupting and understanding them.