Case Study: End of Life Care and the Family

Case Study: End of Life Care and the Family
An 80-year-old man in a coma, with no hope of recovery, is admitted to an
LTC facility where you are employed as a healthcare administrator. The man
has not prepared an advance directive such as a living will or healthcare
proxy. The patient’s religion does not require artificial nutrition or
hydration, and all members of the patient’s family agree that the patient
does not want to die with tubes attached to him. The attending physician
has met with the family prior to completing the PLST form to determine what
orders he will write. The physician informs the family that the patient will
die in a few days without having a feeding tube inserted for water and liquid
food. The feeding tube my keep him alive for a number of years. If there is
no feeding tube for hydration, his death might be painful or uncomfortable.
The physician and the facility’s religious affiliation would prefer to treat the
patient with artificial hydration via a feeding tube rather than do nothing.
The family has refused the feeding tube, and the physician has referred the
matter to the institution’s ethics committee.
Case Study Questions
1. As a member of the healthcare ethics committee, explore to following
a. Transfer the patient to an inpatient hospice, where he can die a
natural death and any pain will be treated with medications.
b. Keep the patient at your facility and go to court for a an order to
insert a feeding tube under the contention that, without the feeding
tube, he will die.
2. Discuss how keeping the patient at your healthcare institution or having
this physician treat the patient would violate the religious stance of both
the organization and the physician.
3. How is this discussion changed if the patient has both a living will and a
healthcare proxy that specifically state he does not want a feeding tube
and he wishes his death to be peaceful, even if that means using
medication to keep him comfortable at the expense of shortening his life?