Question

Mr. Parker is an 88-year-old resident of your LTC home with end-stage Alzheimer’s. He is wheelchair-bound and spends most of his days sleeping in his wheelchair near a window facing the garden. He needs to be spoon-fed but has recently started to refuse to eat. Mr. Parker has three children, one of whom – his only daughter -- is very involved in the care of her father. The team approaches the daughter about her father refusing to eat and feels that his refusal is legitimate. Thus, they propose changing the plan of care to palliation. The daughter absolutely refuses, claiming that “you cannot kill my father, I want everything done to keep him living!”

The director of nursing (DON) for the facility has turned to you, as the executive director, for guidance, asking these questions.

a. Do we know whether the resident is capable of making his own health care decisions?

b. Are there any known wishes from Mr. Parker? What would he want? What are his values?

c. Is his daughter the substitute decision-maker? Can she, in this role, demand treatment and expect that you comply?

Because of the potential legal and reputational liability, the corporate counsel has recommended you respond to the DON in writing. Prepare a 4-10 page memorandum, double spaced addressing the DON and daughter’s issues. Cite relevant sources.

Answer 1

PLEASE DON'T MULTIPLE QUESTIONS AT A TIME AS WE ARE NOT SUPPOSED TO ANSWER MORE THAN ONE QUESTIONS.

a.

The main ethical issue with Mr. Parker is taking health care choices at the end of life treatment.

Parker's daughter did not want palliative care. Yet, she does not engage in the patient's primary care. She is also not in a position to negotiate about the patient's well-being. Furthermore, the patient will not consider his own diagnosis as the right option. He has no proper caregiver who fully participates in care decisions. The desires and beliefs of Parker should be taken into account in the treatment decision-making process. Before making the final decision, the will to live and advanced directives should be checked. If not, instead, given his father, the son who took care of the father should make a decision. The health providers should explain the condition and the need for palliative care that helps improve the quality of life to the patient and his family. To make the correct decision, talk to the family about the patients' positive and negative results.