Question

Case Study #3:

Mr. Wilson, a 51 y.o. male patient, is admitted to the Intensive Care Unit in critical condition after a Case motor vehicle accident. He presented unconscious and is therefore unable to make his own medical decisions. The family of this patient provided a detailed formal advance directive which indicated that in the event of a traumatic injury such as this one, where the outcome is uncertain, the patient would consent to aggressive medical intervention in an attempt to stabilize and determine the severity of his injury. Life-sustaining interventions were therefore pursued.

After a myriad of test and a set of neurologic assessments were performed, it was determined that an anoxic brain injury occurred, and it was not clear whether the patient would ever regain consciousness. The team needed some time to clearly establish a diagnosis, and the family members were kept informed of any progress that was made.

Several weeks passed as the patient stabilized, and the health care team was finally confident that the patient had met the criteria for being in a Persistent Vegetative State, a diagnosis that was presented to the family. According to the advance directive, if the patient were ever in a situation where their continued existence would be in such a state, he would want all life-sustaining intervention withdrawn, and be allowed to die. The family (spouse is no longer in the picture, 18 y.o. daughter, 20 y.o daughter, and 14 y.o. son) are presented with this formal diagnosis of PVS and are willing to continue to assume the responsibility of SDMs. The 14 y.o. son is adamant that his father is a ‘fighter’ and demands the team continue to ‘do everything possible’ and provide the most aggressive care they can. The 18 y.o. daughter agrees with the son, but the 20 y.o. daughter wants to respect her father’s wishes and refuse further life-sustaining measures.

Questions:

• What are some of the ethical issues in this case?
• Who is(are) the designated SDM(s)?
• Who do we listen to when they disagree?
• Can the SDM(s) consent to a decision that would mean the death of the patient?

Answer 1

#Some of the ethical issues in this case are

• 14y old son wants his father to be with life sustaining devices as he is a fighter .At the same time it is agreed by the 18y old daughter. Hence the conflicts of interest arises here. The medical professional wants the patient to have a peaceful end of life where as the children wants the father to be with supportive devices even if it's painful
• The respect  of the patient is a concern because he does not want to survive if there is zero possibility to recover as per his wish .
• The another ethical issues is the ethical principle of autonomy of the older daughter in making a decision which is popped by sibling.
• Principle of beneficence to the patient and at the same time not causing any intentional harm

#The designated surrogate decision maker  here are the 18y old daughter and 20y old daughter legally and the 14y old son morally .

#It is best to listen to the eldest daughter decision when they disagree because it forms a responsibility to support a family console her brother and sister in regards to her father's status and the suffering he may encounter if provided life supporting devices

#The SDM can consent if there is any Advance directive on behalf of the patient .They should be a major or an adult in sound mind to consent to a decision that mean death of the patient .