T. B. is a 91-year-old female found unresponsive at her assisted
living facility. EMS is called and attempts are made to resuscitate
her for 45 minutes before the patient regains a stable heart
rhythm. Due to the lack of oxygen during this time period, the
patient is now fully dependent on a ventilator and is unresponsive
due to anoxic injury to her brain. The physicians have numerous
meetings with the patient’s children and fully explain that the
cardiac arrest has caused permanent damage leaving T. B. fully
dependent on life support and with little to no quality of life.
Taking into consideration her advanced age and now permanent
disability, the physicians’ recommendations include instituting a
Do Not Resuscitate (DNR) order and removal of all aggressive life
sustaining measures in order to proceed with comfort measures and
hospice.
There is significant disagreement among T. B.’s three adult
children and no decisions are made regarding the patient’s DNR
status and continuation of aggressive life-sustaining measures.
Weeks pass by and the patient has begun to develop pressure ulcers
from being bed-bound and pneumonia associated with long term use of
the ventilator. Her neurological status remains unresponsive and
her prognosis poor. The hospital’s ethics committee in consulted
for assistance with the case.
Medical Indicators: 1. What is the patient’s medical problem?
2. Is the problem acute, chronic, critical, reversible, emergent, or terminal, and what are the goals of treatment?
3. In what circumstances are medical treatments not indicated?
4. What are the probabilities of success of the variable treatment options?
5. In sum, how can this patient be benefitted by medical and nursing care, and how can harm be avoided?
Patient References: 1. Has the patient been informed of risks and benefits, understood this information, and given consent?
2. Is the patient mentally capable and legally competent, and is there evidence of incapacity?
3. If mentally capable, what preferences about treatment is the patient stating?
4. If incapacitated, what preferences about treatment has the patient expressed in the past?
5. Who is the appropriate surrogate to make decisions for the incapacitated patient?
Quality of Life: 1. What are the prospects, with or without treatment, for a return to a normal life? What physical, mental, and social deficits might the patient experience if the treatment succeeds?
2. On what grounds can anyone judge that some quality of life would be undesirable for a patient who cannot make or express such judgement?
3. Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?
4. What ethical issues arise concerning improving or enhancing a patient’s quality of life?
5. Does quality of life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?
Contextual Features: 1. Are there professional, interprofessional, or business interests that might create conflicts of interest in the clinical treatment of patients?
2. Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?
3. What are the limits imposed on patient confidentiality by the legitimate interest of third parties?
4. Are there financial factors that create conflicts of interest in clinical decisions?
5. Are there problems of allocation of scarce health resources that might affect clinical decisions?
1, Hypoxic or anoxic brain injury occurs when the brain lack
oxygen.
2, It is a critical condition when the patient is unresponsive,
cardiac arrest cause permanent damage. goal of treatment to provide
support with different illnesses to achieve the best possible
outcome.
3, When necessary condition and improvement nor met, due to her age
and permanent disability medical treatment not indicated
4, Cardiopulmonary resuscitation(CPR) help increase person oxygen
level, brain resuscitation clinical trial of barbiturates therapy
for cardiac arrest, hypothermia protocols are the probabilities of
various treatment option.
T. B. is a 91-year-old female found unresponsive at her assisted living facility. EMS is called...
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