Question

less you need to edit rt's safer to stay in Protected View. Enable Editing 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 unresponsive, witha 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 are 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 test could help in determining his prognosis. The family asked that these test 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, Gail, who had been with Mr. Sussman the previous 3 days, "If this was your father, what would you do?" This situation became an ethical dilemma for Gail as well If you were Gail, what would you say to the family? Depending on your answer, what would be the principles that you might violate? Questions to Help Resolve Ethical Dilemmas What are the medical facts? What are the psychosocial facts? What are the patient's wishes? What values are in conflict?

Answer 1

Being in the place of Gail one can respond in the following way

• If the decision is based on the best interest of the patient then the procedure should be accepted.
• If a jejunostomy tube can prolon his life ,then it necessitates one to accept it rather than denying
• A GCS of 8 is an indicative of coma ,so it The time to respect the patients feeling as well and take decision which will give him a unpleasant hospital stay

The principle which may be violated here are

• Patients autonomy by carrying a procedure without his consent or knowledge
• Causing an incision and pain ,though it is for for beneficial purpose of patient

The medical facts existing in this patient's condition is the patient chances to regain consciousness is very minimal due to hemorrhagic bleed and age, where metabolism slows down and medication can help to manage the symptoms but cannot cure.

The psychosocial facts are the emotions and decision to be made in regards to the patient by their family member.Having a fear of how to manage when taken home,financial expenses, meeting all the personal needs,follow up etc ,with a grab prognosis.All these facts can make the family members in a critical decision-making mind.

The patient's wishes at this stage are generally to have a peace with no physical injury.At the age of 80 ,they tend to accept the spiritual life and go in search of it.

The main values in conflict is a jejunostomy can just extend his life with or without improvement.So it leads to a doubt and query whether to intentionally take the patient for it and prolong his discomfort and uneasiness after the procedure at the same time a child cannot let their parents end their life abruptly and trying to do all possible things to care for them.