Topic: A family divided<\/p>\n
Please read the case study below and answer the questions at the end in paragraph form. Feel free to use as many sources as needed.<\/p>\n
A Family Divided<\/p>\n
A Case Study by Robert L. Potter?
Discussion Questions by Rosemary Flanigan<\/p>\n
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 is only \u201cyes\u201d and \u201cno,\u201d 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\u2019s 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.?<\/p>\n
The patient does not have an advance directive. The patient\u2019s 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 \u201ckill our father.\u201d The patient\u2019s wife is torn between these two positions, but finally requests that the tube be placed.<\/p>\n
?The attending physician and the rest of the treatment team are opposed to placing the feeding tube. Their argument is that the patient has \u201cminimal consciousness\u201d and will not improve. They define this as a futile situation with no reasonable expectation of recovery. Furthermore, two nurses claim that during previous hospitalizations for episodes of cardiovascular events the patient told them that he would not want to be sustained by artificial means \u2014 not by ventilators, renal dialysis, or tube feeding. It is their position that the patient has expressed his preference to not be kept alive in a futile situation.<\/p>\n
?The family requests an ethics consultation.<\/p>\n
Questions for discussion<\/p>\n
1. The judgment of futility should be a conclusion of a communications process, not a beginning. How would you propose beginning the communication??
\u2022 Who should be present?
?\u2022 What information should be shared?
?\u2022 What alternatives are on the table?
?\u2022 What is your goal in participating in the discussion?<\/p>\n
?2. The family is divided over whether or not their husband\/father should be placed on a feeding tube. Consider and discuss the following statements:
?\u2022 The effectiveness of the feeding tube is a clinical matter.
\u2022 The benefits of the feeding tube for the patient depend on the patient\u2019s wishes and quality of life, which the patient or the patient\u2019s surrogate and family must determine.
\u2022 The burdens the treatment (feeding tube) imposes are a consideration for both parties.
?
3. Role play the discussion. Express your assumptions and loyalties and listen attentively to the other speakers.
?
4. Evaluate the role playing experience. Did it affect your view of the case?
If yes, how will you advise the family and the healthcare providers??If not, what is to be done now?<\/p>\n
?5. How would this case have been different if the attending physician had been the one asking for a consultation?<\/p>\n","protected":false},"excerpt":{"rendered":"
Topic: A family divided Please read the case study below and answer the questions at the end in paragraph form. Feel free to use as many sources as needed. A Family Divided A Case Study by Robert L. Potter? Discussion Read More …<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[],"tags":[],"class_list":["post-185099","post","type-post","status-publish","format-standard","hentry"],"_links":{"self":[{"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/posts\/185099","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/comments?post=185099"}],"version-history":[{"count":0,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/posts\/185099\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/media?parent=185099"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/categories?post=185099"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/tags?post=185099"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}