Question

David, who has suffered from ALS for twenty years, is now hospitalized in a private religious hospital on a respirator. He spoke with his physician before he became incapacitated and asked that he be allowed to die if the suffering became too much for him. The physician agreed that, while he would not give David any drugs to assist a suicide, he would discontinue David’s respirator if asked to do so. David has now indicated through a prearranged code of blinking eye movements that he wants the respirator discontinued. David had signed his living will before he became ill, indicating that he did not want extraordinary means keeping him alive. The nursing staff has alerted the hospital administrator about the impending discontinuation of the respirator. The administrator tells the physician that this is against the hospital’s policy. She states that once a patient is placed on a respirator, the family must seek a court order to have him or her removed from this type of life support. In addition, it is against hospital policy to have any staff members present during such a procedure. After consulting with the family, the physician orders an ambulance to transport the patient back to his home, where the physician discontinues the life support.

1. What were the primary concerns of the hospital?

2. What was the physician’s primary concern?

3. When should the discussion about the patient’s future plans have taken place with the hospital administrator?

Answer 1

1. What were the primary concerns of the hospital?

The primary concerns of the hospital are the polices that pertains to life-support patient, euthanasia and regulatory oversights and the legislative implications of such cases. The patient's family too has a bigger say in decisions of life and death situations in such cases. The hospital has multiple fronts to take care such as hospital's own policies, legal implications and also regarding removal of life support, patient's family and their rights, medical and ethical aspects of the removal of life support and administration or hospital board views and polices on such matter to be complied

2. What was the physician’s primary concern?

The primary concerns of the physician is to agree and whether to comply with the pre-arranged agreement between him and the patient regarding discontinue David’s respirator and the extraordinary means keeping him alive. On the other side the ethical ,medical, policies and legal implications of validity of client wises to remove the respirator are a major primary concern.

3. When should the discussion about the patient’s future plans have taken place with the hospital administrator?

The discussion regarding the patient’s future plans should have taken place immediately with the hospital administrator when the patient expressed his views regarding removal or life support in case where extraordinary means keeping him alive would be considered. At that time this aspect could have been considered and discussed with the patient and other stakeholders in the hospital and a sound, legal, medical and ethical decision could have been taken whether to respect or reject David's wishes.