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 Foote had been withdrawn and bedridden, was not able to recognize family or friends, and needed assistance for all basic activities, including feeding and bathing.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 Indiana's "Life Prolonging Procedures Declaration" several years earlier, before she developed her dementia, after a lengthy discussion about end-of-life care with her physician. (The Indiana Declaration states that "if at any time I have an incurable injury, disease, or illness determined to be a terminal condition I request the use of life prolonging procedures that would extend my life. This includes appropriate nutrition and hydration, the administration of medication, and the performance of all other medical procedures necessary to extend my life, to provide comfort care, or to alleviate pain.") 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 report?

Answer 1

Accordong to the Indiana declaration of life prolonging procedures declarations the persons will to prolong life should be protected and so he should be given thrice weekly dialysis if that would help him return to pre kidney failure level of functioning. The phytician cant deny it if there are chances that it would extend his life maximum a couple of years. If the nephrologist trying to deny it depends on his condition dementia and consider its expensive is againist ethics.

A physician who knowingly volates this declaration will be subjected to disciplinary actions under section IC 25-1-9.So it should not be considered legally.