Nurse Betty was working the evening shift when Carl, a 66-year-oldwhite patient, was admitted to the ICU with pneumonia. Carl wassent from the nursing home because of lung congestion and fever. AsBetty reviews Carl’s medical history, she notes that Carl ismentally challenged and is reported to function at about an11-year-old level.
According to the physician’s notes Carl has aspiration pneumoniaand has been ordered a feeding tube and ventilator.
Betty enters Carl’s room, introduces herself, and explains to Carlthat he has been admitted to the ICU for pneumonia. Carl fails tounderstand what the word pneumonia means and asks, “Do I have tohave an operation” and frighteningly states, “I do not want anytubes being put into my body.” Betty explains to Carl that theyhave to treat the pneumonia and that he will need to be put on aventilator and feeding tube to help him recover. Carl begins toprotest and becomes agitated as Betty explains what will be done.Betty tries to explain to Carl that he is very sick and that heneeds the feeding tube and ventilator to help him get well. Carlbegins to shake his head and shouts, “No tubes! Notubes!”
Betty returns to the nurse’s station and reviews Carl’s chart,finding an advance directive completed by Carl when he checkedhimself into the nursing home 3 years previously. The advancedirective clearly states that Carl does not want to be placed on aventilator, receive a feeding tube, or undergo cardiopulmonarymeasures such as CPR. However, the physician wants Carl to beplaced on a ventilator and receive a feeding tube because withoutthe treatment Carl would probably die within a week ortwo.
Carl also has a durable power of attorney for health care on filein which he appointed his sister Margaret to make medical decisionsfor him in the event he was unable to do so. Concerned that Carlreally does not understand what was happening to him, the nursecalls Margaret and explains the entire situation.
Questions
1. What will happen to Carl if he is not placed on aventilator?
2. Was it ethical and appropriate for the nurse to call Carl’ssister Margaret?
4. In your opinion was Carl no longer able to take care of himself?Who makes that judgment?
5. Because Carl said he does not want to be put on a ventilator,would it be ethical for Margaret to authorize a ventilator? Underwhat circumstances?
6. Would removing a ventilator and feeding tube the next day bewrong?
