A 58 year old man develops multi infarct dementia, and is placed in a nursing home. He is alert, responsive, and can walk with a cane, though he has short term memory loss and believes himself to be in his brother's home. Nevertheless, he seems quite happy where he is.
After 2 years in the home, he has a stroke, and upon waking is unable to speak, though he, can fix on objects. He is paralyzed on the left side of his body, and needs a feeding tube for nutrition. After a few weeks in the hospital, he has shown some improvement, but it is not known whether, or to what extent, he will recover his faculties.
The patient signed a Durable Power of Attorney prior to developing dementia which.
states that he does not want to be kept alive by artificial means, including a feeding tube, if 1) he is terminally ill; or 2) he is permanently unconscious; or 3) the burdens of treatment exceed its benefit. He also told his family at that time that he does not want to live out his life in a nursing home. The DPA/HC names his son as his agent, but the son is uncomfortable asking for limitation of treatment. What should the physicians do?
This patient has expressed his wishes through his Advance Directive. The physicians have a duty to uphold what the patient has requested before he was incompetent. The son is uncomfortable carrying out his fathers wishes and should relinquish his right. However,we believe that in this case he is not terminally ill, permanently unconscious and the burdens do not outweigh the benefits. The feeding tube is an ordinary mean to keep the patient alive which means that it cannot be removed. The tube the should be left in until a more definitive proxy can be named.
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