Question

Alice Foote is an 84-year old nursing home patient with advanced dementia who develops kidney failure and is brought into the emergency room. Ms. Foote is currently semi-comatose from the kidney failure, which, like her dementia, was caused by her hypertensive vascular disease (i.e., hypertension). The kidney failure is irreversible; that is, there is nothing that can be done to restore the functioning of the kidneys. However, dialysis can compensate for the effects of the kidney failure by serving as her artificial kidney. The emergency room physician consults the nephrologist (kidney doctor) on-call about dialysis. The two physicians peruse Ms. Foote's medical record and find that, before developing kidney failure, Ms. Foote had been withdrawn and bedridden, was not able to recognize family or friends, and needed assistance for all basic activities, including feeding and bathing. They also discover that Ms. Foote had duly executed a Florida "Living Will" several years earlier, before she developed her dementia, after a lengthy discussion about end-of-life care with her physician. The Florida Living Will states: If at any time I am incapacitated and (initial all that apply) ___AF___ I have a terminal condition, or ___AF___ I have an end-stage condition, or ___AF___ I am in a persistent vegetative state and if my attending or treating physician and another consulting physician have determined that there is no reasonable medical probability of my recovery from such condition, I direct that life-prolonging procedures be withheld or withdrawn when the application of such procedures would serve only to prolong artificially the process of dying, and that I be permitted to die naturally with only the administration of medication or the performance of any medical procedure deemed necessary to provide me with comfort care or to alleviate pain. It is my intention that this declaration be honored by my family and physician as the final expression of my legal right to refuse medical or surgical treatment and to accept the consequences for such refusal. The nephrologist considers starting Ms. Foote on chronic, thrice-weekly dialysis, which will restore Ms. Foote to her pre-kidney failure level of functioning. However, the nephrologist is reluctant to do so because of Ms. Foote's dementia, the cost of dialysis (more than $45,000 per year) and the fact that Ms. Foote's life expectancy even with dialysis is no more than a couple of years. The nephrologist tells the emergency room physician that dialysis is not an option and that Ms. Foote should be returned to the nursing home with instructions about basic comfort care. If Ms. Foote went back to the nursing home without dialysis, she would die, probably in three days. The emergency room physician has called the hospital's ethics committee for advice. You are on the hospital ethics committee, and the committee has asked you to investigate and report back to the committee on the ethical and legal considerations raised by Ms. Foote's situation. What would you say?

Answer 1

Ms.foote's situation is very critical and its hard to say to get the her health back as like her Young's age.As Ms. Foote is 84 years old, and suffering from dementia and renal disease

Her dementia is on last stage, she is unable to recognise even her family members or friends, colleagues or even herslf . She depends on assistant for a daily basic activities. . These all symptoms indicates the physician as Ms. Foote is on the last stage of dementia. This is very common to see in old age. And its consequences of last stage of dementia is very dangerous , not only for their family members or friends even ti herself also. In this condition the person doesn't know to go where and he suddenly we t outside the home , in traffic which leads to the roods injuries or accident and many more.

Ms.foote's also suffered from kidney failure stage , as she might be on a end stage of renal disease which leads to now kidney failure.Her report said to earlier she is the patient of hypertension, which complications of high blood pressure in vascular system leads the renal disease which ultimately progressively end upto to the kidney failure.

According to the given situation above,Ms.foote have to be on a dialysis machine but Ms. Foote denied to go through the treatment because with the age she doesn't want to be medical services to delay her death . She said that "I doesn't want the artificially increasingly the life, it could be possibly upto 1 or 2 years but the death is the nature rule and we can't run away from it by taking the any short cut method or lifeline. This is the last fe not the game. I will accept my death instead of thinking upon that howz painful it is." So she refused the physician order to take the dialysis therapy.

As i am the ethics committee member , I would be go through the reports with deep drive the condition. I talk to the Ms. Foote , and convenience her we all are with you you don't need to afraid of any thing. Firstly rapport should be established between Ms foote and us and also establishing the proper understanding and trust between the patient and us. So she can freely drains her emotions and problem easily.

We should be give. The free dialysis therapy to the Ms. Foote as she is financially weak to pay the therapy's bill. It might be get relief her. And convenience to take dialysis therapy at least once time , as in the old age the patient behaves like a child and especially with the demiantia it adds more childish behaviour so basically we should be treated as perceiving her like a child .just like we are doing in a hospital with child while giving injection to them doll and injection game , just as like that.