End of Life Issues
One patient at Little Falls Hospital is causing ethical issues with end of life decision making for the family her husband and her mom. Lydia, a 45-year-old woman suffered severe trauma in a car accident, six months ago. Lydia is dependent on a ventilator for breathing and a feeding tube for nourishment. The accident left her paralyzed and her awareness is uncertain because she communicates by nodding her head. The patient’s physician Dr. Bob Pritchard, who is in charge of Lydia’s care, is not very confident about her recovery. Lydia’s husband, Mr. Bevin, says his wife would not want to be kept alive in this fashion and does not know the location of her advance directives. Unfortunately, Lydia’s mother, Eileen Redfield, believes in miracles and end of life is not an option for her. The battle of emotions between mother and husband has Dr. Pritchard in the middle. Mr. Bevin states that before their marriage Lydia had written an advance directive but he was unable to locate the document. Without knowing her advance directives, it became the responsibility of her love ones to make the final decision about continued care or termination.
For someone as critical as Lydia, end of the life decisions are not an option for Lydia’s mom. On the other hand, her husband thinks that Lydia should not have to suffer in this way and agrees to end life. It is not easy for anyone involved and having to make an ethical decision to end life. The end-of-life critical care cases tend to experience the most emotional turmoil, and are the most difficult. The CEO of the hospital, Felicia Larue, has asked for a briefing on the status of the patient and alternative methods to protect the patient’s rights and minimize the hospital’s risk. When the patient is unable to speak for him or herself, it becomes the responsibility of a substitute to decide the best interest of the patient. There are two conflicting views that cause major tension for the hospital and the doctors in charge of the patient’s care. First piece of evidence, the patient is paralyzed and requires the assistance of a mechanical device to breathe and a feeding tube for nourishment. Dr. Pritchard is doubtful about her full recovery. Second circumstances, it has been alleged that an advance directive exists, but none has been produce and not available for view. To protect the rights of the patient and the hospital, an ethics committee review is necessary.
The committee will speak with the husband, the mother, and medical staff to establish the best interest of the patient. Because of legal and ethical standards that must be assessed with Lydia’s condition, the committee will make fair decisions. The only issue here is whether to continue or withdraw treatment. The patient is responsive but no real awareness cognitively. It is uncertain what decision the patient would base her decision while head nodding is her only response to questions. The patient is not in a vegetated state nor is she comatose. The question is centered on the patient’s quality of life. The patient’s age is a factor and her visible possibility of recovery is a risk. Since the patient has only been in a paralyzed, state for six months it maybe too soon to withdraw treatment. Until her advance directive can be located, it is in the best of patient and hospital to transfer the patient to the long-term treatment unit and revisit this matter in six months.
Autonomy is the key ethical dilemma in this case study, as the patient has a right to accept or refuse treatment. If in six months, the advance care directive in not located and the patient has not shown any noticeable improvement a reevaluation of the patient care will be reviewed with the committee. Her primary doctor is uncertain of her cognitive awareness, so she may or may not be mentally able to make this decision. Cognitive evaluation of the patient would be helpful to determine if her “head nodding” is relative to her cognition. This is in case, Lydia becomes cognizant, and wants to discontinue treatment, this feeling might change when the initial shock of her condition wears off. An advance directive is usually written with the assistance of a physician and an attorney this committee suggests that family seek these individual in the search for the patient’s written requirements in such an event. The issue of withdrawal of treatment is a serious matter that should not be taken lightly, to this end; the committee requires additional data to form an opinion. It would be helpful to have Personal Representative appointed who’s primary goal is the best interest of Lydia. Ideally, this would be neither a family member nor an employee of the Hospital. Finally, it will be the duty of the medical staff to keep the family abreast of the changes and remain available for questions. The committee, in addition, recommends counseling for the family and weekly consultation with primary care physician.

References
End of Life Issues - You Decide. (n.d.). Retrieved from http://www.devryu.net/re/DotNextLaunch.asp?courseid=9000493&userid=8596510&sessionid
Kaebnick, G. (0041). Taking Sides: Clashing Views on Bioethical Issues (15th ed). McGraw-Hill Learning Solutions. Retrieved from http://devry.vitalsource.com/books/0073531200/id/L4-1-1
Levine, C. (2010). Taking sides: clashing views on controversial bioethical issues (13th ed.). Columbus, OH: The McGraw-Hill Companies, Inc..
Pozgar, G. (2011). Legal Aspects of Health Care Administration (11th ed). Jones & Bartlett Learning. Retrieved from http://devry.vitalsource.com/books/9781449643850/id/ch12lev1sec1