Who Is Lydia's Ethical Dilemma?

After reading your post and many of the colleague in the class, most agree that is not professional to disregard the conversation that the family was having. Although the patient wishes were not to remain on life support and had a document to prove it he also fail to have a proxy to carry one his whishes. The Health Care Proxy is a simple document, legally valid in many states, which allows a person to name someone (an "agent") to make health care decisions their behalf if they are unable to make or communicate those decisions. (Society, 2015).

When a patient is unable to make decisions for himself or herself, their caregivers and those who know them are appointed to make the decisions based on what the patient would have wanted. This is called surrogate decision making. According to the article Terri Schiavo and End-of-Life Decisions “when surrogate decision makers and caregivers cannot agree upon what that choice would have been, they may turn to the courts to determine either what the now-incapacitated patient would have chosen or who is best suited to choose as the patient would have” (Mathes, 2005)

The practically speaking, the case of Nancy Cruzan highlights the fact that an individual cannot rely only on telling his would be decision maker what type of care is desired should that individual become incompetent. Such evidence may not be viewed as sufficient to refuse medical treatment as happened with Nancy Cruzan. It thereby becomes important to record exactly what type of treatment should be accepted or refused if one’s decision making capacity is lost. The most common way to do this is in the form of an advance directive. Such a document would declare not only who the patient wants a surrogate decision maker, but also relates the degree of treatment desired by the patient. The presence of an advance directive makes caring for incompetent patients much easier because confusion over the patient’s wishes is avoided. Had Nancy Cruzan made an advance directive, withdrawing the artificial nutrition

The law effectively covers situations in which a patient can personally consider the effects of terminated treatments, but does not provide for situations in which the patient is incompetent to inform agents of their desires. Conflict occurs when the court requires evidence for consent to end lifesaving medical treatment, which could be otherwise avoided should the Act be amended to accommodate the needs of the patient (for example, conversations held in passing being held as evidence). The Act should be amended to allow families to make the judgment rather than the patient themselves (such as in Re BWV, Ex Parte Gardner (2003) 7 VR 487, 491[19]). Although it is possible to make decisions on a patient’s behalf, clarification by the Victorian state is needed. The legislation fails to make distinctions between the patient’s desires and what is in their best

A patient barrier might include having limited knowledge surrounding life-support systems and treatment options, thereby hindering their ability to fully comprehend or demand certain interventions. Good counseling is therefore essential to overcoming this barrier in implementing the patient’s true and best wishes (Kroning, 2014, p. 222). Another barrier in implementing advance directives concerns the role and influence of family members and the patient. There may be discordance between the desires of the patient and family, which can result in serious debate and tension if not addressed and taken into consideration. Physicians still may have reservations, as certain demands made by the patient may raise ethical concerns in the future, if the provider feels the interventions being done are no longer medically appropriate.

Advance Directives by the patient designates no feeding tubes, artificial ventilation, or CPR. Concerns regarding alteration of mental status consequential to his illness provoke the physician to seek consultation from the designated Power of Attorney. Nursing responsibilities compel the nurse to consider if the proposed actions of Dr. G violate the patient’s rights of self determination and confidentiality and prompt the nurse to advocate for the patient’s desires regarding medical treatment. Health care providers have a responsibility to honor the patient’s autonomy and provide quality medical care (Badger, 2009 p122). Providing artificial nutrition and ventilation transgresses the patient’s directives and is unethical. The physician appears to be asserting a paternalistic approach in deciding what is best for this patient. Should the interventions be temporary and provide resolution of the condition, the physician can defend his actions as being healing and beneficial. However, there is a chance that the interventions may be permanent and futile; avoiding passive euthanasia and terminal dehydration, serving only to prolonging the illness. Violating the patient’s directives of care by performing invasive procedures can lead to legal incriminations of assault and battery.

3. There will be events when the essential advisor will be debilitated, out of town, or generally occupied to give emergency service Another person will rely on upon the outline to make clinical decisions. Satisfactory records can guarantee suitable mediation and progression of consideration as coordinated by the ACA Code of Ethics.

Assist the patent and family, as appropriate, in coming to a consensus regarding the options that best meet the patient’s goal for care.

Before proceeding with a treatment redirection process to withdraw any life sustaining treatment the attending physician and another physician must both agree once again is the patient is still incapacitated and unable t make their own decision. If the patient is still considered incapacitated the redirection process will be approved.

There are some ethical dilemmas evident in this scenario, starting with an End of life dilemma, refusal of care and informed consent.“End of

A 28 year old female with cerebral palsy and debilitating arthritis is in the hospital for treatment. She is immobile and unable to perform basic tasks on her own. Due to her condition, she is having trouble eating and in order to help, the doctor believes that a feeding tube (PEG tube) should be surgically inserted. When told about the treatment, the patient refuses surgery. She is deemed competent and understands her situation. In this situation, I propose that the care team should respect the wishes of the patient and let her die.

The problem that came with Terri’s case is that she did not have an advance directive or desired wishes documented in the situation she was unable to make medical choices for herself. Her husband wanted

A more recent case involving patient decision making when they are no longer able occurred in 2015 with Bobbi Kristina Brown. Bobbi died after spending half a year in a coma due to labor pneumonia. The main similarity between Bobbi’s and Terry’s case was the age of the patients. They were both adults which ended up in a vegetative state and unable to take the decisions for themselves. However, unlike in Terry’s case, Bobbi’s relatives were appointed to handle the decisions regarding her treatment. They gave a chance for Bobbi to recover before making the decision to remove the artificial feeding.

In the case of Mrs. S, after losing consciousness from the overwhelming medication, she is now considered an incompetent patient, someone who cannot make decisions on their own due to lack of competency. In view of the fact that she is unconscious, she is in need of an advance directive, treatment rather than a proxy. With this, her son, assuming her husband is deceased, now has to make life changing choices for her because he next in the chain of surrogacy. Although she has previously declined advanced treatment, her son can now make any decision he wants. By following her wishes, she would follow God’s will for her life and die within a two-week period, but the son does not want to let go of his mother yet, which would result in amputating

When considering a quality end-of-life, one of the key steps a patient should do is to ensure that their legal documents are updated and organized. Legal documents, such as advanced directives, durable power of attorney for health care, and POLST (Physician Orders for Life-Sustaining Treatment), are essential in preventing confusion when it comes to the checkered flag of a patient’s life. One local example is 95-year-old Karen Okada. According to the Honolulu Star-Advertiser, Okada was admitted to the Queen’s Medical Center for her deteriorating health in 2012, and had her advanced directive drafted, and her health care proxy appointed in 1998. It states that she did not want to be artificially prolonged, and states that her brother was