The Feeding Tube
1. Explain how the Patient Bill of Rights applies to this situation.
The patients of the country in the United States are provided a particular right. This right is called the Patient Bill of Rights (Kronenfeld, 2002). The Patient Bill of Rights has a significant impact and is essential for the people who are in the health care organization for the purpose of getting treatment properly and easily. In this scenario, June is suffering from anorexia and the doctors feel she may need to be placed on a feeding tube to save her life. June agreed to the procedure but became combative, disoriented and refused to have the tube place the evening before the procedure was to take place.
The patient bill of rights applies, as the patient has a right to know what treatment options are available to one and what the possible outcomes may be. The patient has a right to decide one’s medical care. One also has a right to know of any side effects of treatments. June needs to be told what may happen without the feeding tube and what can be expected with the feeding tube. June also has a right to have her health information kept confidential, with information given only to those she designates as being allowed to have her health information (Showalter, 2008).
It is noted that in the absence of a progressive terminal disease, the feeding tube may be used to prolong life and since the patient is not dying of another cause, discontinuing the feeding tube would imply a desire to cause the patient’s death. In this context most of the controversy occurs. If the patient is able to express one’s views now, or in the past has clearly expressed one’s desires on this issue, they should be considered. Too frequently, a statement is made in very clear-cut terms whether or not to use a feed tube. It would be wiser, rather than saying yes or no, to discuss the context in which one would not want a feeding tube and allow for situations where one would be willing to have one. If there is not a clear understanding of the patient’s wishes in a particular situation, the decision falls to the designated power of attorney for health care or whoever is in the decision-making role (Dunlop, 2006).
There is no right or wrong choice for it is one’s choice. If one’s family or friends disagree about one’s desires, these important decisions are left to the physician by default. Consent must be voluntary, competent, and informed. Voluntary means that, when the patient gives consent, one is free from extreme duress and is not intoxicated or under the influence of medication and that the doctor has not coerced the patient into giving consent. Consent is also inferred when an adult or child is found unconscious, or when an emergency otherwise requires immediate treatment to prevent grave harm or death (“Patient Rights”, 2011).
2. Based on the facts given in the scenario, would the patient be considered competent to decide? Explain your answer.
June was competent to decide what type of care she would receive, until she became disoriented. However, unless she has an advanced directive to spell out what she wishes if she were to become incompetent, there is no way to force her to have the feeding tube placed.
In the Quinlan case, courts determined that family members may refuse life support on behalf of an incompetent patient (Merisel, 1991). New York and Missouri have strict requirements that surrogate decision makers’ present clear and convincing evidence that one, if competent, would not have wished artificial nutrition and hydration given their present medical condition. Courts have recognized written statements and conversations with family and friends as clear and convincing evidence (Milkes, 2011).
Most state legislatures have passed laws allowing an advance directive to be honored. An advanced directive is a statement that one makes while competent expressing one’s wishes about treatment in the future, should they lose the capacity to make decisions. It may provide written instructions about treatment such as a living will or may designate another person to make treatment decisions such as a proxy or durable power of attorney (Milkes).
In addition, one may appoint someone by signing a health care proxy or durable power of attorney for health care decisions. When this is done, one gives the healthcare agent to authorize admission to medical, nursing, residential or other facilities, enter into agreements for one’s care and authorize medical and surgical procedures. One may also give the agent instructions that he or she has to follow. An agent can makes sure healthcare professionals follow one’s wishes and decide how the wishes apply as medical conditions changes. Hospitals, doctors, and other healthcare providers must follow the agent’s decisions as if they were one’s own (“Healthcare Proxy”, 2010). If one’s healthcare agent is not aware of one’s wishes about artificial nutrition and hydration, the agent will not be able to make decisions about these measures.
3. Explain the primary responsibility of June’s doctors.
The responsibilities of June’s doctors are to ensure she receives the best care possible under the circumstances and to do so while following her wishes. The doctor’s responsibilities also require that June is given information about treatment options and possible outcomes. In an emergency situation, the doctors have flexibility in providing medical care for one who is incompetent, only to the point that once the crisis is over, they are no longer able to make such decisions. The doctors are required to use whatever means necessary until that point. The doctors would be required to place the feeding tube at this point.
It is the doctor’s ethical responsibility to determine whether the patient has executed an advanced directive whose provisions may apply to the placement decision, prior to feeding tube placement in a pronouncement incapable patient. Otherwise the physician should take lead in discussing with the patient’s surrogate decision maker or health care agent the pros and cons of long term tube feeding and a summary of discussions regarding tube feeding should be documented in the medical record (Friedrich, 2010).
It is the responsibility of the doctors in health care organizations to provide the best quality of treatment to patients in health care organizations. In this scenario, the doctors should make sure one is given the kind of treatment which will help to save one’s life as the current condition of one is critical and doctors have the responsibility to take full care of the patient (Showalter).
The doctors must recognize responsibility to patients first, and foremost, as well as to society, to other health professionals, and to self (“Medical Ethics”, 2001). They must maintain her safety and health. They have the facts and know what is good and what is bad for a patient and should work according to the intelligence and knowledge they have about the treatment. If June resists getting the treatment, the doctors should move forward and give treatment to provide June the best results. They should also confer with the relatives of one to convince one that it would be beneficial to get the food tube to ensure June gets the best treatment.
In summary, the doctors should also consider the care and well-being of the patient, plan care in accordance to patient wishes, and to keep patient and family informed of patient status and all health options. Assurance of best quality services is breached along with faith if the patient or physician neglects one’s responsibilities which may affect one’s health care (Showalter). References
AMA – principles of medical ethics. (2001). Retrieved February 21, 2011, from http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/principles-medical-ethics.shtml
Dunlop, J. T. (2006). The feeding tube dilemma: key questions. Retrieved February 22, 2011, from http://cbhd.org/content/feeding-tube-dilemma-key-questions
Friedrich, L. (2010). PEG tube feeding at the end of life-when it’s appropriate, when it’s not. Today’s Dietitian, 12(4), 42.
Kronenfeld, J.J. (2002). Health care policy: issues and trends, volume 759. Westport: Praeger Publishers.
Merisel, A. (1991). Legal myths about terminating life support. Archives of Internal Medicine, 151(8), 1497-1502.
Milkes, D.E. (2011). "Tube feeding" — right or wrong: the medical, legal and ethical issues. Retrieved February 22, 2011, from http://www.thedoctorwillseeyounow.com/content/aging/art2071.html?getPage=2
Patient rights. (2011). Retrieved February 21, 2011, from http://legal-dictionary.thefreedictionary.com/Federal+Patients%27+Bill+of+Rights
Showalter, J.S. (2008). The law of healthcare administration (5th ed.). Chicago: Health Administration Press.
What is a healthcare proxy? (2010, March). Retrieved February 22, 2011, from http://faxtonstlukes.com/healthcare-proxy