CASE : Disagreement among surrogate decision-makers and with advance directive

A 72-year old woman who was admitted to the Neurological Intensive care unit following a cerebral hemorrhage which left her with severe brain damage and ventilator dependent. One year before this event, the patient and her husband had drawn up "living wills" with an attorney. She was diagnosed by her attending physician as being in a permanent unconscious condition. The patient's living will specified that the patient did not want ventilator support or other artificial life support in the event of a permanent unconscious condition or terminal condition.

The patient's husband is her legal next of kin and the person with surrogate decision-making authority. When the living will was discussed with him, he insisted that the patient had not intended for the document to be used in a situation like the present one. Further discussion with him revealed that he understood that the patient would not be able to recover any meaningful brain function but he argued that the living will did not apply because her condition was not imminently terminal. He further indicated that he did not consider his wife to be in a permanent unconscious condition. The immediate family members [the couple's adult children] disagreed with their father's refusal to withdraw life support.

The treatment team allowed a week to pass to allow the husband more time to be supported in his grief and to appreciate the gravity of his wife's condition. Nevertheless, at the end of the time, the husband was unwilling to authorize withdrawal of life support measures consistent with the patient's wishes as expressed in her living will.

1. What are all of the ethical and the legal parameters [there are at minimum 3-4] involved here and why?

2. Understanding that there are both ethical and legal implications involving this case, as the Health Care manager of this facility, what should be done in this case and/or how would you "manage" this situation?

Note that there are only two [2] questions to this case but the points are substantial

- Be sure to answer each aspect of the question and DO NOT write in generalities. You must be specific.

- Also let me remind you that all APA format papers should have an introduction and a conclusion.

- When referring to Question #1 [ethical/legal parameters] use TORT Law terms such as: a. negligence, b. duty to care, c. breach of duty, d. injury, e. Causation ~OR~ advance directive and living will verbage etc. DONOT just re-state what you think are the violations or concerns.

- Remember as indicated on the Case, there are at MINIMUM 3-4 legal issues. Make sure you list at least that minimum number.

- When referring to Question #2 [What should be done and how would you manage the situation] Be specific! You are in charge.