Running head: You Decide Week 5

End of Life Issue Chandra Beasley Keller Graduate School of Management Health Rights and Responsibilities HSM 542 March 4, 2013 Professor Gomillion

You Decide Week 5 End of Life Issues

Six months ago, Lydia, a 45 year old woman suffered severe trauma in a car accident. The accident left her completely paralyzed. The doctors were not sure of her cognition because all she able to do is nod her head. Lydia is dependent on a feed tube for nourishment and a ventilator for breathing. The medical professionals in charge of Lydias care were not optimistic about her recovery. Lydias husband, Mr. Bevins, says his wife would not want to live this marginal existence, unfortunately, Lydias mother, Eileen Redfield, believes in miracles. The battle of emotions between mother and husband has Lydias primary care physician, Dr. Bob 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 wishes, it became the responsibility of her love ones to make the final decision about continued care or termination. End of the life decisions are never easy for anyone involved. It is the end-of-life critical care cases that tend to be the most emotionally charged, and the most intractable, because these are the cases in which the most is at stake. The CEO of the hospital, Felicia Larue, has asked for a briefing on the status of the patient and alternative methods to protect the patients rights and minimize the hospitals explore. When the patient is unable to speak for self, it becomes the responsibility of a surrogate to decide the best interest of the patient. There are two conflicting views that cause major agitation for the hospital and the doctors in charge of the patients care. Fact one, 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 recovery. Fact two, there is evidence of advance care directive but the actual document is not available for view. To protect the rights of the patient and the hospital, an ethics committee review is needed. The committee will speak with the husband, the mother, and medical staff to determine the best interest of the patient. Because of legal and ethical standards that need to be examined, the committee can be fair impartial. The only issue here is whether to continue or withdraw treatment. The patient is responsive but not truly cognizance. It unsure what decision based on head nod would be her choice. The patient is not in a vegetated state nor is she comatose. The Quinlan/Conroy standard would not apply. The question is based on the patients quality of life. The patient age is a factor and her apparent likelihood of recovery. 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. 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. An advance

You Decide Week 5

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 patients 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 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 Walker, R. M., (2005). Ethical issues in end-of-life care. Retrieved October 5, 2012 from http://www.moffitt.org/moffittapps/ccj/v6n2/article4.htm Levine, C. (2010). Taking sides: clashing views on controversial bioethical issues (13th ed.). Columbus, OH: The McGraw-Hill Companies, Inc..

You Decide Week 5