Question

A forty-five-year-old man with a three-year history of cardiovascular disease has entered the hospital with a stroke that has paralyzed his right side and caused him to aspirate food of any consistency. His mental status is clouded and there is disagreement as to whether or not he has decisional capacity. His language capacity is only “yes” and “no,” and his responses are inconsistent. The attending physician is convinced that the patient has lost decisional capacity while two family members are equally convinced that he has decisional capacity. The patient’s wife and two other children are ambivalent about his competency to make decisions. The prognosis for recovery of safe swallowing and speech approaches zero because of the dense damage to the cerebral cortex visible on brain imaging. Two neurological consultants have verified that recovery is likely to be minimal and that permanent, severe disability will be the outcome. The patient does not have an advance directive. The patient’s wife says that they never did discuss his preferences about life-sustaining treatment. She is convinced that he would not want to live in this disabled condition but is uncertain whether to request the placement of a feeding tube. Two of her four adult children are strongly opposed to the tube placement, while the other two insist that not to do so would be to “kill our father.” The patient’s wife is torn between these two positions, but finally requests that the tube be placed. The attending physician and the rest of the treatment team are opposed to placing the feeding tube. Their argument is that the patient has “minimal consciousness” and will not improve. They define this as a futile situation with no reasonable expectation of recovery. Furthermore, two nurses claim that during previous hospitalizations for episodes of cardiovascular events the patient told them that he would not want to be sustained by artificial means — not by ventilators, renal dialysis, or tube feeding. It is their position that the patient has expressed his preference to not be kept alive in a futile situation. The family requests an ethics consultation 
5. How would this case have been different if the attending physician had been the one asking for an ethics consultation

Answer 1

Ethics consultation is handled by the bioethics team in an hospital.The patient's wife or children's are the concerned person who are in need of a ethics consultation to take a decision. A physician if asks for an ethic consultation can mean various things like

• Responsible to support and guide the family members with the help of some experts
• This has a chance for the physician to be defamed by the family members for the act,and can create a mistrust,loss of hope on the entire medical team
• This may even make the family members think that the physician is not concerned of keeping a patient alive in a futile stage and not bothered of an emotion of the family
• The quality of the service provided by the attending physician can be a query to the family members in regatds to their skill in handling critical patients
• The decision making skill of a physician can be poor or unsatisfactory.