Question

An 87-year-old female resident has lived in your nursing home for three years. She was initially placed there by Adult Protective Services after her two daughters were determined to be stealing her medicines. She has end-stage Alzheimer's disease, is noncommunicative, and requires total feeding assistance. A living will is on file, indicating the resident's wish for no artificial means of prolonging her life, and she is also under the care of a local hospice agency. One of her daughters now has power of attorney. The daughter approaches you with a copy of her mother's membership certificate in the Hemlock Society, which advocates assisted suicide. (Assisted suicide is not legal in your state.) She also brings you a book published by the Hemlock Society. She claims that total feeding assistance is an artificial means of prolonging life and violates her mother's wishes. She asks that you stop the feeding and allow nature to take its course. The nursing staff reports that the resident eats relatively well. Her weight is stable, although she is assessed as being at high risk for pressure ulcers and weight loss. CNAs can tell you her favorite foods, based on facial expressions. She seems to especially like strawberry milkshakes; she smiles, smacks her lips, and sucks on the straw vigorously to the last drop. The ethics committee will be meeting with the daughters, hospice agency representatives, and the nursing home's attorney.

In your opinion, what is the biggest challenge with this situation for the leader of this facility?

If you were the decision maker, the Administrator, that will ultimately be held responsible by regulatory agencies for any decisions made and the ultimate outcome of this situation, what actions do you think you would you take and why? Who would you consult? What actions would you not take and why? Be sure to consider how your own personal beliefs and life experiences have potential to impact your actions, decisions, facility policies and interaction with residents/families.

Answer 1

The biggest challenge here is to educate the daughter about the basic requirements or eligibility of a patient for assisted suicide though there is living will stating no artificial means to prolong life.Here the patient though not responding verbally is able to react to the type of feeds through facial grimace which is an act of accepting the treatment willingly.

Some of the actions which could be taken in place of a administrator are

• Getting help from the ethics committee to clarify the daughter's request is acceptable or not
• Gathering information from the primary care provider in regards to the patient status,this gives a clear image of the condition of the patient about the prognosis
• Counseling to the daughter in handling critical situations
• The personal beliefs and life experiences can impact the actions in the following ways
  • Being sensitive, while making decision can hinder the appropriate decision which can benefit the patient and the family members
  • Expecting the daughter to raise a legal notice for permitting assisted suicide
  • The either decision can impact the family.This will make the family members to go through a stage of grief to overcome the situation.