Question

Case Study

David, who has suffered from ALS (Amyotrophic Lateral Sclerosis aka "Lou Gehrig's disease, a neurodegenerative disease leading to nerve damage with permanent muscle paralysis) for 20 years, is now hospitalized in a private religious hospital on a respirator. He spoke with his physician before he became incapacitated and asked that he be allowed to die if the suffering became too much for him. The physician agreed that, while he would not give David any drugs to assist a suicide, he would discontinue David's respirator if he asked to do so. David has now indicated that through a prearranged code of eye movements that he wants the respirator discontinued. David had signed his living will before he became ill, indicating that he did not want extraordinary means keeping him alive.

The nursing staff has alerted the hospital administrator about the impending discontinuation of the respirator. The administrator tells the physician that this is against the hospital's policy. She states that once a person is placed on a respirator, the family must seek a court order to have him or her removed from this type of life support. In addition, it is against their policy to have staff members present during such a procedure.

After consulting with the family, the physician orders an ambulance to transport the patient back to his home, where the physician discontinues life support.

Please answer the following Case Questions (20 points):

1. What were the primary concerns of the hospital?

2. What were the physician's primary concerns?

3. When should the discussion about the patient's future plans have taken place with the hospital administrator?

4. What is the physician's liability for the death of this patient due to the withdrawal of life support in the patient's home?

Question text

Case Study

David, who has suffered from ALS (Amyotrophic Lateral Sclerosis aka "Lou Gehrig's disease, a neurodegenerative disease leading to nerve damage with permanent muscle paralysis) for 20 years, is now hospitalized in a private religious hospital on a respirator. He spoke with his physician before he became incapacitated and asked that he be allowed to die if the suffering became too much for him. The physician agreed that, while he would not give David any drugs to assist a suicide, he would discontinue David's respirator if he asked to do so. David has now indicated that through a prearranged code of eye movements that he wants the respirator discontinued. David had signed his living will before he became ill, indicating that he did not want extraordinary means keeping him alive.

The nursing staff has alerted the hospital administrator about the impending discontinuation of the respirator. The administrator tells the physician that this is against the hospital's policy. She states that once a person is placed on a respirator, the family must seek a court order to have him or her removed from this type of life support. In addition, it is against their policy to have staff members present during such a procedure.

After consulting with the family, the physician orders an ambulance to transport the patient back to his home, where the physician discontinues life support.

Please answer the following Case Questions (20 points):

1. What were the primary concerns of the hospital?

2. What were the physician's primary concerns?

3. When should the discussion about the patient's future plans have taken place with the hospital administrator?

4. What is the physician's liability for the death of this patient due to the withdrawal of life support in the patient's home?

Answer 1

1. What were the primary concerns of the hospital?

The primary concern of the hospital is that the hospital wants to take legal decision with the treatment. The hospital wants the family members to have to decide on the treatment plan. And the staffs are prohibited to be present in that situation. The hospital also has a strict policy against doctors aiding suicide.

2. What were the physician's primary concerns?

The physician is in a situation of an ethical dilemma of whether to follow the hospital policy or patient's wishes. The hospital policies force him to follow the end of life treatment but the patient has signed the living will on not to be resuscitated. So the physician most concern about David's pain and his outcomes.

3. When should the discussion about the patient's future plans have taken place with the hospital administrator?

Patient's future plan should be discussed immediately after the patient's admission. The patient, family members, medical team have to discuss the concerns of patient condition, treatment plan, percentage of a positive outcome, complications which can arise during the treatment plan. The family members have to take a decision on life supporting devices on behalf of the patient as he is not in a state to decide. Even though the patient has signed the living will, the family members have to take the final decision in this situation.

4. What is the physician's liability for the death of this patient due to the withdrawal of life support in the patient's home?

According to the code of ethics, the refusal of life-sustaining treatment is based on patient preference. the patient has the autonomy to take the decision on end of life treatment. On behalf of the patient, the surrogate decision maker has to decide on the withdrawal of life-sustaining devices. The physician has to follow the ethical principles of having proper consent and advanced directives before withdrawing of any life support in order to prevent the legal issues.