Question

Health care ethics

Case A.

Twenty-nine year old Janet and her husband Jack were driving home from her ob-gyn appointment when tragedy struck. Another driver, elderly and distracted by an incoming text message, ran a red light and T-boned Janet and Jack’s Mini-Cooper. Both young people sustained severe injuries.

Jack died en route to the hospital. Janet survived, but with massive head injury. Her physicians now say, a month after the accident, that the prognosis is grim – continuation for some time in a persistent vegetative state (PVS). Janet had completed her own advance directives some months ago, naming Jack as her primary agent and durable power of attorney for healthcare decisions. She named her parents as secondary agents and they had received a copy of their daughter’s advance directives. Janet also had completed, with notarized signature, a healthcare treatment directive. Among her directives was a clear, handwritten statement about life prolongation if she were, somehow, “to end up in anything like PVS, from which I am not apt to recover.”

With Jack gone, treatment decisions are left up to Janet’s parents. After consulting her physicians, other family members, and even their priest, a decision is made to stop everything except palliative care. Plans are made to transfer Janet to a hospice unit in another part of the hospital. It would take place the following day.

A resident physician notices in the patient’s chart that Janet is pregnant, probably about nine weeks. She wonders if this matters, legally or ethically or religiously, for her patient’s transfer to hospice, especially when Janet is not imminently dying otherwise. The resident does a bit of online research and learns that in the State of Kansas, a woman’s healthcare directives about “withholding or withdrawal of life-sustaining procedures in a terminal condition” may not legally be in effect while pregnant.

“The declaration of a qualified patient diagnosed as pregnant by the attending physician shall have no effect during the course of the qualified patient’s pregnancy” (KSA 65-28, 103, (4)B). A note in the patient’s medical record the next morning references this statute, with a question about how it potentially impacts the impending transfer to hospice care. When the attending physician reads the note, she calls Janet’s parents and says hesitatingly, “We have a bit of a problem here. It appears we may need some legal assistance, perhaps an ethics consultation, and must postpone Janet’s transfer of care.” The doctor explains further what her young resident colleague had discovered, and questioned.

Postpone? Ineffective advance directives? Continued life support? Did the doctor really say that? That there may even need to be surgery for a feeding tube and a tracheostomy while this legal glitch is being discussed and gets clarified?

Almost in unison, Janet’s mother and father protest, “But, Doctor, our daughter didn’t want this!”

What should be done now for Janet and her parents, and on what grounds? What values underlie the statute making a pregnant woman’s healthcare treatment declarations of “no effect” while pregnant? Do you agree or disagree with this statute, and on what grounds? What decision would you be making as Janet’s parental surrogate, and why?

Answer 1

Advance directive is a legal document intended to ensure that healthcare providers honor a patient's decisions regarding treatment, even when he or she is no longer able to communicate those decisions.

Yes ,I agree with with this statute. As janet is pregnant ,its not only about Janet but also about her baby health . For saving the baby the advance directive has to be without as per legal ethics and after her delivery it should be continued if her condition remains the same .