Question

: A 73-year-old female admitted to hospital with aspiration pneumonia and sepsis. Past medical history of multiple CVA’s, PEG tube feeding, multiple pressure ulcers. Patient able to open eyes but not able to follow any commands or respond verbally. Patient came to hospital from home with her wife. On admission, the wife was adamant that the patient be a full code. Wife seemed to be unclear regarding patient’s current medical/functional condition, and the health care team felt that due to unrealistic expectations of the wife, the patient was suffering. The team was struggling with the goals of care that were demanded. Goals of care were only changed when a new physician took over the care of the patient and was willing to intervene.

Questions: What are some of the ethical issues in this case?

• Must the physician/health care team acquiesce to all demands by a substitute decision-maker? What were the reasons she provided for wanting “full code”?
• What would the patient want in this case if she could tell the team? What would it mean to support her wishes?
• What reasons were given by the first physician to not make the patient full code? And from the second physician for agreeing to full code?

Answer 1

1. Ethical issues in this case are:

- Health care team workers get confused because the answers provide by the patient's bystander may not be claer.

- Problematic relationships and moral distress.

- Honesty vs. withholding information.

- Autonomy vs beneficience.

2. No, the health care team may not acquiesce to all demands by a substitute decision maker. The reasons she want Full Code because ; -

- the patient was not able to follow the commands, also not able to respond verbally

- She may felt her husband is going to die .

In this situation the health care team should make her more relax and calm and should tell that everything going to be normal and no need to worry. The health team should give confidence to her that nothing will happen to her husband, and they should tell that they will handle the patient more carefully.

The reason why first physician not to make patient Full Code because, they thought that the patient wife is not clear and unrealistic about the patient, and may be physician thinks that she is not telling anything right about the patient condition.

The second physician agreed for Full Code because the patient was not responding to commands verbally, the patient seems to serious because of aspiartion pneumonia and sepsis the patient blood gets infected and it will affect the malfunctioning of systems in the body.