Discussion Case Study: When is it time?
You have been called in for an ethics consult to assist in sorting through a complex situation, fraught with conflict. There is an elderly man with severe dementia who is having recurrent aspiration pneumonia. The wife and family want him put on a respirator to help with his breathing and so that he would no longer aspirate. The physician feels that this is futile and will not benefit the patient, but the family is insisting.
Medical History:
The patient is a 90 year-old white male with severe dementia. He is not able to communicate, but does open his eyes to his family's words and touch. He has had Alzheimer's disease for 10 years. He is being fed with tube feedings and is adequately nourished. He is well cared for in a nursing home where his wife visits him every day. He is not in any apparent pain or suffering. He does have severe dysphasia and continually aspirates some of the tube feeding and even his own saliva. He was admitted with his fourth episode of pneumonia in the last 6 months. He is not responding well to the antibiotics and is not clearing the pneumonia. The family has asked that he placed on a respirator to protect his lungs-even if has to live on it forever.
Social History:
This man is a retired pastor and his family is very religious. They believe that life is sacred and that everything should be done to prolong life and therefore, it is important to their religious beliefs to care aggressively for him. He does have an advance directive that he would want tube feedings and resuscitation, even if severely mentally impaired. His wife is designated as his legal health care representative and she is 88 years old. On interviewing her, she is pleasant, kind but slightly forgetful. There is one adult daughter who interacts with the team well but is pleasantly persistent that further aggressive care be given to her father.
200-300 words and includes support by citing references (using APA formatting).
Discuss the ethical issues this case presents and your recommendation for resolving this apparent conflict.