The patient, Mrs. A, is 72-years-old woman with Alzheimer's disease.
She was transferred from a nursing home to this acute care facility because of multisystem organ failure, including congestive heart failure and impaired renal function. She also had a urinary tract infection( UTI) secondary to serratiia. The patient had a long medical history and was well known at this hospital.
Mrs. A's history was significant for ongoing hypertension and a pulmonary embolism (PE) ten- years prior. Post PE, the patient had a number of cardiac and pulmonary complication which had contributed to rapid progression of the Alzheimer's. Two years before the current admission, Mrs. A suffered a brain stem stroke with" locked in" syndrome. She was intubated and a gastrostomy tube was inserted. Mrs. A was able to understand spoken and written words. She was hospitalized for an extended period ( several months) and eventually transferred to a nursing home. Physical therapists saw little, if any, rehabilitation potential in the patient.
Mrs. A had lived with her husband until the stroke two years ago Mr. A had his own health problems. He was an insulin dependent diabetic with a lower limb amputation above the left knee. Because of his physical challenges, Mr. A realized that he could not take care of his wife and consented to the nursing-home placement. He was quite upset by this state of affairs but seemed rational in discussing the treatment issues and the appropriate course of action. A son from San Francisco, Jeremy, also arrived at the hospital and told the attending physician and staff that all decisions should come through him since his father and mother were" obviously no longer capable of handling these things." Jeremy concurred that nursing-home placement was appropriate and should be initiated.
The current hospital admission was approximately one year after that placement episode. Mrs.a was still ventilator dependent, and her mental status had deteriorated over the course of the year to the point where a preliminary diagnosis of persistent vegetative state(PVS) was made. The husband was grief stricken and agreed with the attending physician that limitation of aggressive treatment seemed appropriate. Nevertheless, Mr. A wished to speak with his minister regarding what his religion had to say on the matter. After two conferences with his ministerand the hospital chaplain, Mr. A agreed that a do-not-resuscitate (DNR) order should be entered on the chart. He also began to favor withdrawal of the respirator although a final decision had not been reached when the attending physician received a call from Jeremy's attorney. The attorney stated that treatment should not be limited in any way until Jeremy arrived in town and reviewed the situation.
When jeremy arrived, he was accompanied by his wife who was seven-months pregnant. Jeremy wished his mother to kept alive until his wife delivered the baby so that his mother could" see her grandchild." Mr. A believed that Jeremy had " taken leave of his senses" since Mrs. A could not "see" anything and that to prolong her indignities for two additional months would serve no purpose. Nevertheless, the fear of Jeremy bringing a lawsuit temporarily froze the decision-making process.
Summary, Medical indication, patients preference, quality of life and contextual features( if the family are consensual, pluralistic, protective or laissez faire). 5 paragraphs( one paragraph for each question) all together is 4 pages with double-spaced.
This material may consist of step-by-step explanations on how to solve a problem or examples of proper writing, including the use of citations, references, bibliographies, and formatting. This material is made available for the sole purpose of studying and learning - misuse is strictly forbidden.While the case of Mrs. A—and, by extension, Mr. A and their son Jeremy—is a complex one, particularly in terms of the plethora of medical conditions afflicting the unfortunate patient, the scenario can be comprehensively and accurately summarized. Mrs. A, 72, had a long medical history of progressively more serious and debilitating conditions which necessitated hospital admission and stay, followed by placement at a nursing home, and then the current admission at an acute care facility – prompted primarily by multisystem organ failure and congestive heart failure. Perhaps most relevant to the bioethics of the case is the fact that Mrs. A’s mental condition has progressed from “locked-in” syndrome to, according to the current and preliminary diagnosis, a persistent vegetative state (PVS). Her husband, in accordance with his religious beliefs...