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 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 Teeding 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 or recovery. Furthermore, two nurse that during previous hospitalizations for episodes of cardiovascular events the patient told them that sustained by artificial means - not by ventilators, ren events the patient told them that he would not want to be their position that the patient has expressed his prer means - not by ventilators, renal dialysis, or tube feeding. It is situation. le patient has expressed his preference to not be kept alive in a futile

Answer 1

Medical futility means that the proposed treatment should not be performed because the available data shows that it will not improve the patient's condition.

1. The communication regarding the judgment of futility should begin with the discussion on the patient's present condition. All of the family members should be present during the discussion The prognosis of the patient should be discussed. What may be the possible complications of being bedridden e.g bed sores, contractures, etc. The caregiver roles and responsibilities, etc. The goal of the discussion is that the family members may take a unanimous decision regarding the treatment of the patient.

2.The effectiveness of the feeding tube is a clinical matter.

The feeding tube is a tube inserted into the gastro-intestinal tract (stomach) via the nose or the oral cavity for the purpose of providing nutrition to the patient when the patient is unable to take himself or herself. Feeds in the liquid form can be provided to the patient every 2hrly or 3 hourly intervals.

The benefits of the feeding tube is determined by the patient's wishes and the quality of life, which the patient, patient's surrogate and family members decide.

Placing a feeding tube may cause a body image disturbance for the patient. Also, the person taking care of the patient should develop the skill of feeding the patient (when and how, what position to be used for feeding, what all foods can be given, how frequently the feed to be given, how much to be given, etc.

The burden the feeding tube imposes is to be considered by both the parties.

The feeding procedure, The complications of feeding, that is aspiration, thus causing respiratory arrest, etc

4. I will advise the patient's relatives to give care to the patient as long he has life by giving him supportive treatment.

5. If the attending physician was the one who was asked for consultation he would have recommended insertion of a feeding tbe and to provide supportive treatment to the patient.