Sally Jones, a 82 year old, bl
Sally Jones, a 82 year old, black female is admitted in thehospital with multiple strokes. She doesn’t recognize or respond tonursing staff, physicians, or family members. Mrs. Jones hasextremely poor heart function and is in congestive failure. Thedoctor in charge of the case contacted the family to discuss hercondition and the type of care he should provide her. He alsostates ” there is no more we can do”. Her son understands thecondition and agrees with DNR (do not resuscitate) order, but thedaughter refuses and insists of continuing with the treatment.Based on the information, please answer the followingquestions:
1. Can the doctor decide to withdraw care without the consent ofthe family?
2. Have any principles of ethical decision making been violatedin this case? Explain your response.
Answer:
Ans) Futility of Treatment: When the physician recognizesfurther treatment will be of no benefit to the patient.
– Morally the physician has a duty to inform the patient whenthere is little likelihood of success of further treatment.
– Determination to futility of medical care is a medicaldecision based on scientific evidence.
• Do-Not-Resuscitate (DNR) are physician orders not toresuscitate a patient in the event of a cardiac or respiratoryarrest
DNR’s are:
– Generally written as the result of a patient wishes or at thefamily’s request.- Orders must be written form, signed and dated by thephysician
So, Doctor must fully explain the patient’s condition and informthem that now is the time that nothing more can be done & ifthe family members still refuse then the doctor cannot decide towithdraw care without the consent of family & he can still givethem time to think about this till then he needs to continue thetreatment.
2) Principles of ethical decision are notviolated in this case as:
These are 6-step process for thoughtful and responsibledecision.
- Establish the facts in a situation- Doctor called the familymembers for explaining the patient’s condition & about thetreatment response.
- Decide whether the situation involves legal or ethical issues-As the treatment will no more benefit the patient so consent offamily will be required.
- Identify your options and possible consequences: Determiningthe need of consent
- Evaluate your options: Without the family consent, Doctorcannot discontinue the treatment
- Choose the best option- Explain the family members aboutPatient condition & still give them time to think for theconsent.
- Implement your decision- Though the famolf as yet not givenfree wish consent to discontinue the treatment so till the doctorhasn’t withdrawn the treatment
So in this case there is no violation of ethical principles.
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