Question

This is a theoretical case taken from VHA Intensive Ethics Advisory Committee Training, 1998, as presented...


This is a theoretical case taken from VHA Intensive Ethics Advisory Committee Training, 1998, as presented by Arthur R. Derse MD, JD. An 87-year-old woman widowed for six years, who is otherwise healthy, was visiting another city and abruptly became ill. She was seen in the emergency department of the local VA and admitted to the on-call physician. The on-call physician (who has not previously seen her) made the diagnosis of bowel obstruction arid made arrangements for a surgeon to evaluate her. The surgeon recommended surgery and obtained her consent for surgery. The surgeon expects an uneventful recovery. She is told that she will be on a ventilator for a short time after surgery. The patient tells the surgeon that is OK as long as it is for a short time. She tells the surgeon that she does not want to be dependent upon machines. She was asked upon admission whether she had an advance directive. She replied that she has a living will and a power of attorney for health care which names her daughter (who does not live in the area) as her health care agent. The patient undergoes surgery, which is successful in treating the underlying problem and does not show any malignant causes, but in the recovery room she has a cardiopulmonary arrest and is resuscitated. She is transferred to the ICU in the care of the on-call physician. The physician attempts to wean her gradually from the ventilator, but this is unsuccessful. Three days later, she has regained consciousness but is still intubated. Though she cannot speak because of the ventilator, she is able to write and asks that the tube be removed. The attending physician tells her that she is dependent upon the ventilator and the patient needs to remain on the ventilator until she can breathe on her own. She writes that she understands that she may die, but she does not want to be on machines. Her only children -- a daughter and son -- - have arrived. She repeats her wish to them that she wants the tube removed. She writes to her daughter that "I don't want to die, but we all have to die sometime, and I don't want to have to live on a machine. I know that whatever the outcome, God will take care of me." Her daughter tells the physician that her mother is adamant that she be off of machines and she respects her mother's wishes, even if she cannot breathe on her own. She says this is consistent with her previously expressed wishes and her religious beliefs. Her son tells the physician that he disagrees with his sister -- since his mother does not have a terminal condition, he can not see why she should not be forced to put up with the ventilator until she can be weaned from it. He feels that she is being shortsighted, and she will be thankful to have been kept on the ventilator when she is finally able to be weaned. Describe the criteria for giving "legal" consent. Were all elements met in this case? In other words, did the patient demonstrate decision-making capacity? Explain

Homework Answers

Answer #1

-In end stage phase,ventilatory support itself leads to distress and despondency,particularly if the patient is unconscious.Invariably,it is impossible to wean the patient off the ventilator in the terminal stage of disease.
-Usually ,there should be no medical or legal hassel in withdrawing the ventilatory support if the patient's condition is irretrievable.It may be argued that if assisted ventilation has not been proved to be productive and beneficial to the patient,it should be discontinued.But if the brain is not yet dead,legal troubles may ensure.
-in the opinion of supreme court,withdrawal of life support should be considered synonymous with a kind of euthanasia.
-so the termination of ventilation under compulsion would stand illegal ans unlawful.
-As patient is not in a condition to take decision appropriately for her condition.

Know the answer?
Your Answer:

Post as a guest

Your Name:

What's your source?

Earn Coins

Coins can be redeemed for fabulous gifts.

Not the answer you're looking for?
Ask your own homework help question
Similar Questions
Legal and Ethical Issues:Case Study Cathy Smith, an eighty-eight-year-old woman, was admitted to the emergency room...
Legal and Ethical Issues:Case Study Cathy Smith, an eighty-eight-year-old woman, was admitted to the emergency room from the nursing facility with acute respiratory distress. Although Smith does not have a living will, her daughter Rose, a health care professional, has the power of attorney (POA) to make her mother's health decisions. Smith suffers from end-stage Alzheimer's disease and recently experienced congestive heart failure. Her condition is alarming. The doctors want to place her on life-support equipment, including a ventilator. Smith's...
Legal and Ethical Issues:Case Study Cathy Smith, an eighty-eight-year-old woman, was admitted to the emergency room...
Legal and Ethical Issues:Case Study Cathy Smith, an eighty-eight-year-old woman, was admitted to the emergency room from the nursing facility with acute respiratory distress. Although Smith does not have a living will, her daughter Rose, a health care professional, has the power of attorney (POA) to make her mother's health decisions. Smith suffers from end-stage Alzheimer's disease and recently experienced congestive heart failure. Her condition is alarming. The doctors want to place her on life-support equipment, including a ventilator. Smith's...
Case Scenario: The patient is a 72-year-old widowed Native American woman named Rose Smith.  Mrs.Smith lives alone...
Case Scenario: The patient is a 72-year-old widowed Native American woman named Rose Smith.  Mrs.Smith lives alone near Traverse City.  Her son, daughter-in-law, daughter and their children all live outside of Michigan.   Her income is $15,000 per year and her healthcare coverage is traditional Medicare (Parts A, B and D).  She does not have access to a car.   Mrs. Smith is diabetic and routinely receives care at the local health clinic.  For hospital care she must travel to Traverse City. Mrs. Smith tripped in her...
READ AND FIX GRAMMER Facts a. This case is patient to the physician about the right...
READ AND FIX GRAMMER Facts a. This case is patient to the physician about the right to die. The nature of the case is a thirty-two-year-old Nancy Cruz who was in a persistent vegetative state since 1983 could not order the physician to remove artificial nutrition. In 1983 she was in a car accident, and she was found face down in a dish without respiratory or cardiac function. She was unconscious on the accident and paramedics were able to restore...
Transitions in Care Case Study Rochelle is a 15-year-old girl who had been admitted from the...
Transitions in Care Case Study Rochelle is a 15-year-old girl who had been admitted from the ER for an emergent laparoscopic appendectomy one week ago just after Christmas break. She returned two days’ post discharge with abdominal pain, nausea, vomiting, abdominal bloating and fever. She went under an exploratory abdominal surgery to determine what the issue was. It was found that during the laparoscopic appendectomy the surgeon clipped her bowel and she now had peritonitis with multiple abscesses. She had...
Read the following case study Competency and End Stage Cancer You have just been consulted, in...
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...
A young woman age 28 was committed to a local psychiatric hospital because she her paranoid...
A young woman age 28 was committed to a local psychiatric hospital because she her paranoid delusions had taken a violent turn with family members and a caregiver. A physician at the institute administered Resperidone injections, an anti-psychotic medication, against her will to reduce her violent outbursts. The mother of the patient was given the medical power of attorney by a court who declared the woman mentally incompetent. The Resperidone worked to make the woman less prone to violent outbursts...
Word Bank: autonomy beneficence non-malfeasance fidelity justice paternalism ethical relativism feminist theory deontology utilitarianism virtue ethics...
Word Bank: autonomy beneficence non-malfeasance fidelity justice paternalism ethical relativism feminist theory deontology utilitarianism virtue ethics veracity loyalty duty Activity: Read each description below, and under each description, type the appropriate term being described from the word bank. Each term may be used more than once if necessary. You will not use all of the terms. (2 pts each / 24 pts total) Group of answer choices The patient has started taking antidepressant medication and does not want her children...
CHINESE CASE STUDY #1 An elderly, Asian-looking man is admitted to the emergency room with chest...
CHINESE CASE STUDY #1 An elderly, Asian-looking man is admitted to the emergency room with chest pain; difficulty breathing; diaphoresis; vomiting; pale, cold, clammy skin; and apprehension. Three people, speaking a mixture of English and a foreign language to one another, accompany him. The nurse tries to speak English with the man, but he cannot understand anything she says. Accompanying the elderly man are two women (one elderly and very upset and one younger who stands back from the other...
Shamus’s family come to talk to you about their his care. They want to speak to...
Shamus’s family come to talk to you about their his care. They want to speak to you because they trust you as someone who has worked very closely with Shamus as a palliative care worker for the last two months. They are very distressed about a report they have received from the doctor, who has told them that Shamus has only days to live. His family ask you to refer them to a different doctor – there must be something...