Question

Read the following case study

Competency and End Stage Cancer You have just been consulted, in your role as health care administrator, about a case that's happening in the oncology wing. The doctor has phoned you because he knows you have experience about informed consent and decision-making capacity from your MHA program. The patient, Eric, is a 32-year-old male with melanoma that has metastasized to both his brain and his throat. The chemotherapy and radiation are no longer working and the doctors predict that Eric has no more than three more months to live. Eric has a living will that states that he would not want any extraordinary measures in the event that he has an incurable disease and the measure would only serve to prolong his dying. Eric's brain tumor is making him forgetful and sometimes confused about why he is in the hospital. His lucidity waxes and wanes. As the tumor to his throat has enlarged, Eric has begun complaining about pain and discomfort. He is having trouble speaking to his family and friends and, sometimes, it is challenging to breathe. Because the neck tumor is fast growing, there is a possibility that it could make it impossible for Eric to breathe, and he could pass away from this. His attending physician speaks with Eric and his three siblings at the bedside and informs them that there are three options: do nothing, surgically remove the tumor, or perform a tracheostomy. His three siblings immediately object to both surgery and the tracheostomy, stating that Eric does not want his death to be prolonged. Eric agrees with them, but then later in the night he pulls a nurse aside and tells her that he does want the tracheostomy. He says he is afraid of dying and is "not yet ready to go." Since speaking to the nurse, Eric has been sleeping frequently and experiencing a lot of confusion. What would you recommend the physician do in this case?

post the following considerations to the discussion board:

1. Using the "Process for Determining Competency of Patients Who Refuse Medical Treatment" on p. 135 of your Morrison & Furlong text, explain whether Eric currently has the capacity to make decisions.
2. Whose wishes do you think should ultimately be respected? Eric as he is currently stating them, Eric's siblings, or Eric as stated in his advance directive? Justify your answer using the concepts of informed consent, informed refusal, competency, and patient autonomy you have read about this week. In your answer, consider that the decision you make may have wider implications for other patients in the hospital as well as Eric.

Answer 1

Due to the brain tumor , Eric is getting confused and forgetful . So, according to me Eric currently does not have the capacity to make decisions. Also while he was inbetween sleep he made the request for tracheostomy which he had objected out in the day . Another support is his living will in which he does want anything which will prolonge his suffering and provide him pain .

So , the request for tracheostomy made at night should not be considered as it has no clarity and also if want we can take the suggestion from his siblings .