Question

Justin – A Case Study

Justin is a 65-year-old single gentleman who suffered a traumatic brain injury when he fell from a ladder while painting his house. He was found by his neighbors who broke into the house after noticing that his mail had been piling up for several days. He has been in the hospital ICU for three weeks and has remained unresponsive. Justin is somewhat of a recluse. His neighbors know little about him except that he retired from his job a few years ago. He does not socialize in the neighborhood and rarely leaves his house.

With much difficulty, the social work department has located Justin’s older sister, Louise. Louise tells the social worker that she and Justin have another sister, Joanna who lives in New Mexico. Justin not been in touch with his sisters for years and Louise suspects that he may have a problem with alcoholism. Nevertheless, both sisters are very concerned about Justin and agree to be his surrogate decision maker according to the state law provisions.

The doctors have painted a rather grim prognosis for Louise and Joanna in terms of Justin’s recovery, telling them it is unlikely that he will ever regain consciousness. Justin is at the point where a tracheostomy and a feeding tube would have to be inserted for long term care. The other option for the sisters to consider is withdrawing the ventilator and providing hospice care if Justin survived. The doctors also explain that Justin would be unlikely to survive a resuscitation attempt should his heart stop and therefore want Louise and her sister to consider a Do Not Resuscitate Order (DNR).

Louise believes that her brother has been through enough and thinks he would not want to live like this even on the small chance that he might recover consciousness. Joanna had been very close to her brother growing up and s heartbroken to see his life ending in this way. She believes that he should be given “a fighting chance” and that they should do everything they can to keep him alive including resuscitation. She is certain that the brother she once knew would do the same thing for her. She is also extremely offended when she hears a resident refer to her brother as a “vegetable” and remarks that he might as well be dead.

*The case study is a fictitious composite of real-life scenarios.

Based on the case study, respond to the following questions:
The ICU nurse calls you – the ethicist – and asks you to help these two sisters sort out the options for care that the doctor has put before them.

• How would you help these two sisters decide what is in Justin’s best interests?
• What information would be needed?
• Using the Four Boxes Approach to Bioethical Decision Making, come to a recommendation for how the staff should proceed with Justin.
• What do you think should happen if the two sisters cannot agree?
• How should the comment by the resident be addressed?

Answer 1

The sisters can be helped in the following way

• Educate them about the status of the patient and the actual disease condition and its prognosis
• Reinforce the sister in regards to the truth and making them to decide by themselves
• Provide psychological support to both the sisters especially Joanna because of her sensitivity and affection towards her brother

The information like the coping mechanism of the sister has to be known in prior. In regards to the patient, progress or detoriating has to be known in prior to explaining the sisters

As the patient cannot make decision by self ,neither the sister are in a stronger mind to make a clearer decision due to the critical situations. The staff has to be suggested to follow the principle of non maleficience because of lack of decision from the sisters,doing against them can be a legal concern to the healthcare professionals and the hospital.

When both sisters cannot agree ,it can lead to a concern to the healthcare sector to provide care for a long period without any actual benefit for the patient. They may be in a state to get legal advice from the court

The resident comment should be addressed with respect and to be clarified with doubts in regards to the patient care.