Want to Do Hospital Committee Ethics? (1): Withdrawal of MNH
This scenario will be the first in a series of scenarios that are examples of what hospital ethics committees experience. One of the roles of ethics committee members is to come to a consensus and inform the stakeholders about the ethics and the current law regarding the issue and anticipated action.
For this exercise to be of interest and worthwhile, it will require my visitors reading the scenario to contribute their comments regarding the issue. Remember, you don’t have to be a professional ethicist to give an opinion; you just have to be an interested member of society.
FACTS:
94-year-old Catholic woman with advanced Alzheimer’s Disease,
5-year resident of a Catholic care facility.
A feeding tube to provide medical nutrition and hydration (MNH) was placed a few years ago because of difficulty swallowing during a prolonged respiratory infection, with the intention that it would be temporary but the feeding tube still remains in the patient. It is not clear why the tube was left in place but, perhaps, it was providing good nutrition without complications and was more efficient for the nurses.
The patient now has moderately severe trouble swallowing attributed to Alzheimer’s..
The patient has no terminal illness. She has only severe Alzheimer’s yet is still aware of her environment.
Years ago, while mentally competent the patient prepared an Advance Directive stating that she did not want medical nutrition and hydration(MNH).
The family wishes to have the feeding tube removed.
There has been no recent change in the patient’s condition.
THE ISSUES:
Should the feeding tube be removed now from the patient? Is the intention of removal of the tube a decision to end the patient’s life, if she can’t be adequately given oral food and fluid or is the decision to relieve the patient of an extraordinary burden imposed by the tube. Should the physician be compelled to have the tube removed even if the physician, for moral and religious reasons, does not want to write an order for this act?
What if the nurses refuse to follow an order to have the tube removed?
Would it make any difference in the analysis of the issue if the patient was NOT Catholic and was a resident in a NON-CATHOLIC care facility?
DECISIONS: Now it is up to you my dear visitors to tell us all your opinions. ..Maurice.
posted by Maurice Bernstein, M.D. @ 9:25:00 PM
1 comments
1 Comments:
The patient has made her wishes known at a time when she was a capable decision-maker. The tube should be removed and the patient should be allowed and encouraged to take nutrition and hydration by mouth. A speech therapy evaluation can determine the risk for aspiration and specific measures that can be taken for this patient to minimize that risk (thicken liquids, no straws, chin tuck when swallowing, exercises that could strengthen swallowing)and let nature take its course. Respiratory infections can be treated supportively (i.e. antibiotics by mouth, oxygen, breathing treatments)without involving hospitalization.
Being a Catholic facility with presumably Catholic nursing staff, the physician may need to remove the tube himself.
The patient being Catholic does not affect the decision because there is an advance directive.
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