Jason Barber N362 Ethical Dilemma presentation: Synopsis of Case #5 Case 5 Tom is a 56-year-old man with a history of chronic

renal failure and diabetes. He suffered a respiratory arrest and was on a mechanical ventilator for 3 weeks. He was successfully weaned from the ventilator but he suffers irreversible brain damage due to hypoxia. He currently receives tube feeding with some water four times a day to maintain hydration and nutrition. He has an advanced directive that is in his private physician's medical record. A niece confides to the nurse that her uncle did not want to survive being a vegetable and "unable to do anything for himself." She believes this is expressed in his directive. However, the primary physician who is a personal friend of the family is reluctant to discuss this as the immediate family (wife and children) wants all measures to keep him alive. Wife has durable power of attorney for medical decisions. The niece asks you to help adhere to her uncle's wishes. Viewpoints Tom: Unable to communicate wishes but has advance directive Niece: Believes her uncle Tom does not want to remain alive with his significant brain damage; believes this is stated in the advance directive. Physician: Personal friend of the family; does not want to go against family wishes. Family: Wants to do everything to keep Tom alive Wife: Wants to keep Tom alive and is POA for medical decisions Nurse: Wants to find a solution Ethical Principles Autonomy(the patient has a right to choose and refuse treatment Toms expressed these rights through his advanced directive and therefore is legally binding to the healthcare team and Toms wife as the DPOA). Beneficence/Nommaleficence(Toms physician and supporting staff such as nurses have an ethical and legal responsibility to know and follow their patients advance directive. This is a balance of risk and benefit) Veracity( The principle is trust. The physician must be truthful in telling Toms wife as the DPOA what Toms advanced directive states and legal responsibilities to follow Toms advanced directive wishes. Relevant Values Altruism (The concern for the welfare of others. The players include the physician, nurse and all other hospital staff. The staff has a responsibility to give care for Tom and concern for his welfare) Autonomy

Human Dignity (The hospital staff should know and respect Toms advanced directive regardless of their personal feelings, such as the physicians close friendship with the family and Toms current status as physically and mentally disabled. Integrity (The physician and the nurse should be honest with Toms wife, DPOA and Toms condition and his advanced directive. Social Justice (Toms disability which is brain damage may influence unfair treatment or treatment against his advanced directive wishes.

Rights Informed consent (the wife has the right to be informed about any medical decisions or actions taken regarding her husband) Right to Healthcare (the wife has the right to accept or refuse medical care for her husband based on the advanced directive) Right to Privacy (this is entailed in the laws of HIPAA) Right to Refuse Care (in accordance to the advanced directive Tom has a right to refuse care in his state) Laws HIPAA Advanced Directives Options In this case we considered three major options, assist the niece, honor the wifes DPOA status, or contact the private physician. If we assist the niece there are many ethical principles, values, and laws that we would be upholding. However if we did assist the niece, we would be violating HIPAA. Our second option would be to honor the wifes DPOA status; a major benefit of this is we would be upholding her autonomy as DPOA. However we may also be violating Toms autonomy if he specified different wishes in his advanced directive. Our last option would be to contact the private physician of Tom and encourage him to discuss the advance directive with Toms wife. This upholds many of the ethical principles, values, and laws involved in this case. The one major drawback of this is that we may violate the autonomy of Toms wife as DPOA. Our final decision is to contact the private physician to speak with Toms wife about the advanced directive and encourage her to uphold her husbands wishes. This choice is based on the alternative that maintains the greatest ethical principles, values, rights, and upholds the law.