Ethical
Dilemma - 1
A 96 year man who has become very frail is brought
into hospital because he fell at his care home. It
is recognised that there has been a considerable physical
decline recently and he has become dependent on carers
for most activities. There is no reason to suggest
a lack of capacity to make any decisions.
The nurse in charge asks the junior doctor whether
the patient is for resuscitation.
Does the doctor ask the patient about this decision?
Does the doctor avoid burdening the patient and makes
the assumption that resuscitation would be futile and
inappropriate after all “he is very old”?
Is a best interest assessment involving members
of is family ethical without consent from the patient?
Is a resuscitation decision necessary?
Consider what processes could be used to solve this
dilemma?
Discussion
Professionals need to consider a framework to approach
dilemmas like this.
The first question should be does a decision need to
be taken? If not, don’t ask the question.
Would resuscitation be futile in context of a clearly
described decline and an expected natural death? If
a treatment is futile we should not be offering this
choice. Raising the question with the patient might
even cause distress. A boarder assessment including
some of the principles of “Best Interests” must
be taken and is the responsibility of professional
in this case. There is no ethical obligation to offer
a therapy that is clinically inappropriate (GMC
Withholding and Withdrawing Life Prolonging Treatment:
Good Practice in Decision Making 2002)
If there are no clear answers or in the situation
of disagreement amongst staff, patient / relatives
then a formal process of local and senior review
must be taken. Failure to resolve issues at a local
level might lead to the referral to the courts. |
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