Question

Mr. Sussman, 80 years old, was admitted to the neuroscience unit after suffering a left hemispheric bleed. He had a total right hemiplegia and was completely nonresponsive, with a Glasgow Coma Scale score of 8. He had been on IV fluids for 4 days, and the question was raised of placing a jejunostomy tube for enteral feedings. The older of his two children asked what were the chances of his recovery. The physician explained that Mr. Sussman's current state was probably the best he could attain but that “miracles happen every day” and stated that tests could help in determining the prognosis. The family asked that these tests be performed. After the results were available, the physician explained that the prognosis was grave and that IV fluids were insufficient to sustain life. The jejunostomy tube would be a necessity if the family wished to continue with food and fluids. After the physician left, the family asked the nurse who had been with Mr. Sussman during the previous 3 days, “If this was your father, what would you do?” This situation became an ethical dilemma for the nurse as well.

1) If you were the nurse, what would you say to the family and why? Be specific in exactly what you say and the rationale. Depending on your answer, what would be the ethical principles/morals that you might violate? State specifically and give the rationale for each answer.

Answer 1

Considering the age of Mr. Sussane and the severity of the injury that he has had i would say the recovery seems to be very poor.

The longer time Mr. Sussane remains in coma the poorer will be the prognosis and the chances of going into the vegetative state increases.

But it would be the call of the family to decide whether to support for jejunostomy. I would rather explain the procedure of jejunostomy and it's advantages and disadvantages for the patient. Since IV fluids are not sufficient enough to sustain life enteral feeding is essential.

Family can surely spare some time to evaluate patients conditions after the procedure is being done.

As it is at the age of 80 patients are not willing to undergo any procedures so it will purely be dependent on the condition of patient and family acceptance.

Asking family to discontinue with all life support would violate my nursing principle as it will promote more to euthanasia or mercy killing.

Hence as a nurse I would be counselling the family to undergo the treatment which is rational to patient health.

I cannot be the decision maker for the patient.