May 12, 2010
An 86-year old woman suffered a massive intracranial hemorrhage, was admitted to the hospital through the emergency room, intubated and then extubated per her wishes in her advance directive. Since suffering her stroke she has been in a persistent coma with no meaningful response to verbal stimuli, only spontaneous movement on the right side and facial grimacing.
The patient wrote an advance directive in 2004 witnessed and talked over with by her son but not discussed in the intervening years. On her form she initialed the life-sustaining procedures she wished withheld or withdrawn if she is in an “irreversible condition as a result of injury, disease or illness, such as extreme mental deterioration and two physicians have certified that her condition is terminal or cannot be significantly reversed.”
Those conditions are: antibiotics, CPR, respirator, radiation, surgery, prescribed medications, chemotherapy, and kidney dialysis. What she DIDN’T initial were artificial nutrition and artificial hydration. When a feeding tube was mentioned, the son agreed saying that, since her advance directive was being followed in other ways, it ought to be followed here, too.
She died with a feeding tube. I support inserting the feeding tube; if advance directives are our moral and constitutional right, then they ought to be followed.
A colleague at the Center makes an excellent argument – the feeding tube ought not have been offered. It is not palliative; it does not benefit her; it is futile.
What do you think?
Labels: medical ethics; medical futility; advance directives