Mary is a 90-year old woman who has been in hospital several weeks. She has a COPD exacerbation, increasing difficulty swallowing, and pneumonia. She has said repeatedly she is tired of being in hospital and tired of fighting to breathe. She doesn’t want a feeding tube or her IV but wants to be allowed to die comfortably.
Mary’s daughters who have been regular, frequent visitors, say she has always been a fighter and would never want to give up. They believe she is just discouraged and are requesting everything be done to keep her alive including a feeding tube, IV hydration, and mechanical ventilation if it becomes necessary.
The resident in charge of Mary’s care calls the ethics request line.
- What are the ethics issues in this situation?
- What underlying values are at stake?
- Should Mary or her daughter’s have decision-making authority?
- How would you respond to this call for ethics support?
- Who should be involved in the discussion?
Some Values and Ethics Issues to Consider
- Informed consent
- Substitute decision-making
- Advance care planning and personal directives
- Quality of life
- Respect for human dignity
- Respect for patient autonomy
- Patient-family relationships
- End-of-life decision-making