Question

Chapter 7 Bioethical Issues 161 Issues in Practice Mrs. Ada Floral, who is 82 years old, had just suffered a massive stroke that ren- dered her unresponsive. Her large family-consisting of her husband of many years, three sons, and two daughters-was very upset. Although she was breath- ing on her own, she had no voluntary movements and seemed to be completely paralyzed. Magnetic resonance imaging (MRI) showed a large area of bleeding around the midbrain and brain stem. Her pupils were constricted and unrespon- sive. The physician explained that the prognosis was extremely grave and that the likelihood of Mrs. Floral's survival was minimal. However, the family members all agreed that everything should be done, so the physician reluctantly initiated aggressive medical therapy with intra- venous (IV) glucocorticoids, osmotic diuretics, antihypertensives, and physical therapy. After a week, there was no change. The family wondered whether Mrs. Floral might be "starving to death" and asked the physician to have a feeding tube inserted and feedings started. One month later, the still unresponsive Mrs. Floral is being cared for at home by her family with the supervision of the local hospice and home health-care program. She is off all IV medications; however, she is receiving some medica- tions, a commercially prepared feeding, and water through the feeding tube. Some of the family members are beginning to question whether they did the right thing by insisting that everything be done and wish to remove the feeding tube so that Mrs. Floral can die a peaceful and dignified death rather than just hanging on for months. Other family members feel that if they give permission for the tube's removal, they would be killing their mother and could not live with the guilt. The hospice nurse in charge of the case has discussed the issue with the family. She, too, believes that once a feeding tube has been placed, it should not be removed, even if all the family agrees on its removal. She feels that it's not an issue a family can "just change their minds about. Although she is in frequent contact with Mrs. Floral's physician, she has not mentioned that the family is thinking about removing the feeding tube in fear that the physician might agree. Questions for Thought 1. Is the hospice nurse correct in her belief about the removal of the feeding tube? 2. When do tube feedings stop being beneficial to clients? 3. What ethical rationales could be used for removing the feeding tube in this case? 4. Is there a right to death with dignity?

Answer 1

1.no.she should have discussed the thought of family with the physician as patient has right to get peaceful death.

2.if the client is not responding to any medication or treatments or client is in coma it is not necessary to insert a feeding tube.

3.respect the family members decision as they are inxluded in treatment plan.autonjomy is the ethical concern can be used.

4.yes,patient has the right to death with dignity .