Oct 22, 2006

When does a patient become "incapable"

More on the same patient I mentioned in the last post (with the crazy family).

She needs a Mitral Valve replacement. Hers isn't working sufficiently to move blood through the heart. Clotting has already developed on it and had caused a Stroke/CVA already.

The problem is....she doesn't want to be treated. Sick all her life, she's says she's done. Now diagnosed in the past as Bipolar and Schizoaffective, the family and the doctors have deemed her "mildly retarded" and incapable of making her own medical decisions. It took 3 ethics committee meetings to determine this.

Personally, I disagree. She's been my patient for an entire week and I think she is completely of sound mind. (Albeit an emotional and sometimes kind of hostile mind)
But they determined that this patient will get the open heart surgery she doesn't want.

This patient with a history of pulling out tubes, thrashing against restraints until undone, and throwing things across the room at the staff with be tied up in ICU for a week and then probably sent back to us with a healing open chest.

Yeah, If anything goes wrong....Who does the crazy family sue? Is it right to make a patient go through that kind of recovery without their permission?

I just find it odd that the "mildly retarded" diagnosis wasn't spoken until after she needed heart surgery.


At 05:59, Blogger Unemployed Nurse Jack said...

I have an Ethics journal coming due soon, for which I have to select an incident during clinical and write about my ethical conflict.

My issue (has to do with a nurse communication to a patient and the doctor's orders) pales in comparison to the one you describe facing in your job. Wow.

As an aside, last week I worked with a patient who was receiving comfort measures only. The chaplains were in the room with his granddaughter asking for clarification before they let her sign the out-of-hospital DNR and they kept asking her "Is he able to understand?" "Does he want CPR?" And so on.

I finally said "He can understand if you want to ask him yourself." I couldn't stand the "talking about the patient in front of the patient" going on while he was awake and could comprehend questions, although he struggled to communicate his answers. Either take it outside or ask the patient and have her answer for him. Ugh.

At 00:03, Anonymous Anonymous said...

medical ethics is such a wide ranging subject with hardly any easy decisions. i took a semester class on bioethics which dealt with a similar situation as yours, as well as other issues like the environment, etc. i think we spent at least two solid weeks debating the "right to life" laws and whether or not the hospital/state has the right to determine if you are fit for care and if they do, how much your family is required to go along with what they recommend.

i would love to go on and on about this, but it would go much easier on the phone (hint hint)

At 18:07, Blogger Jo said...

Hey Jimmy,
You just have to call me earlier even though I know you are on CA time now. :P
You mentioned "fit for care" which is always a misconception in the medical field. Everyone is "Fit for care" no matter what their "end of life" status is.
The issue is always how much are we going to poke, prod, slice open, and compress to someone who is ready to meet their maker. "Care" and "comfort" is always a right.

At 16:09, Blogger kate loving shenk said...

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At 02:13, Anonymous Anonymous said...

it wasn't meant to mean "fit to be cared for". i meant to say "fit to make their own decisions for care"....


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