Mr. Jones, a 72-year old male, was admitted for coronary artery bypass surgery. The bypass surgery itself was successful, but Mr. Jones suffered a stroke during the procedure and never regained consciousness. During his lengthy stay in the hospital, he was placed on kidney dialysis, was permanently on a ventilator, had a feeding tube inserted and received several transfusions. After several months, he was diagnosed by his physician, Dr. Lee, as being in a persistent vegetative state (PVS). Mr. Jones was transferred back and forth to a transitional care unit, the hospital and eventually to a nursing home that had the resources for ventilator support and dialysis. After returning to the nursing home for
When treatment is futile but the patient (or the family or health care surrogate) insists on “doing everything possible to keep him or her alive, ” what process exists to resolve the conflict? Who decides what to do when treatment is futile, the physician or the patient? How can physicians and institutions best comfort the dying who have no hope of recovery? How can communities educate the stakeholders – patients, families, physicians, hospitals, and nursing homes – in order to prevent this conflict at the end of life?
Why Develop Medical Futility Guidelines? A Case Study
Mr. Jones, a 72-year old male, was admitted for coronary artery bypass surgery. The bypass surgery itself was successful, but Mr. Jones suffered a stroke during the procedure and never regained consciousness. During his lengthy stay in the hospital, he was placed on kidney dialysis, was permanently on a ventilator, had a feeding tube inserted and received several transfusions. After several months, he was diagnosed by his physician, Dr. Lee, as being in a persistent vegetative state (PVS).
Mr. Jones was transferred back and forth to a transitional care unit, the hospital and eventually to a nursing home that had the resources for ventilator support and dialysis. After returning to the nursing home for a second time, his condition again deteriorated and he was transferred again to the hospital. This transfer to the hospital was precipitated by a serious bout of gangrene and his left leg was amputated below the knee. While in the hospital, his daughter was appointed his legal guardian.
Dr. Lee began to have serious doubts with the earlier decision to continue to treat Mr. Jones so aggressively. Mr. Jones, still in PVS, was by now a full code. His daughter insisted on “doing everything possible to keep him alive. ” At one point, her father’s minister was called in to assist in making the decision whether to continue treatment or not. The minister believed that the aggressive treatment should be stopped. The daughter refused to listen and asked that the minister not be allowed to see her father. Neither of the brothers was willing to disagree with what their sister was demanding. The lawyer on the hospital ethics committee was consulted, and consequently asked the court to permit the discontinuation of aggressive treatment by withdrawing the ventilator and dialysis. The court did not agree. Mr. Jones still languishes in the hospital bed.
What will happen to Mr. Jones?