mr. r., a 42-year-old architect, is comatose in the critical care unit as a result of an electrical shock accident. mr. r. is catholic but does not attend mass, whereas his wife and children, ages 20, 18, and 14, attend often. mr. r. is on a ventilator, and his condition is deteriorating. he has been placed on vasopressor agents, which are required to maintain his blood pressure at 90/60. mr. r. has told his wife that he never wants to be placed on life support. when the youngest child was visiting her father, she was certain that she felt him squeeze her hand. the family is attempting to make a decision about withdrawing life support. medical insurance will cover the medical bills.

1. what is mr. r's main health problem?
   
2. what is the ethical problem in mr. r's case?
   
3. what additional information can you gather from mr. r's family and his care team?
   
4. who is the decision-maker for mr. r?
   
5. what ethical and moral principles are involved in mr. r's case?
   
6. are there any alternative options for mr. r?
   
7. what decisions can be implemented at this point?
   
8. the last step in ethical decision making is to modify and evaluate actions. what would you expect to need modifications in the upcoming weeks/months?
   

well, what have you come up with so far?

Mr. R seems to have had a living will, but his wife seems to have the durable power of attorney, which is what Mr. R didnt want. But in the event the patient is incapacitated, the health care professional may disclose personal information if in his judgment is impaired and they do what is in the best interests of the patient.

you really haven't answered the questions. when someone has an accident the emergency response teams (calling 911) have no choice, but to resuscitate a person. that is written into most state laws. check yours. state laws are also pretty clear about living wills. without a durable power of attorney or living will in place, the health care system has no choice but to resuscitate the patient and keep him alive by artificial means unless he is brain dead and saving him is hopeless. all hospitals have a committee that reviews these kinds of cases and you should check to see what this committee does at the hospital where you do your clinicals to get an idea of what would be done and what kind of information and options would be available to this patient and family so you can answer the questions for this scenario. a dnr order or order to withdraw life support is not made without this ethical committee getting involved. the first thing you need to do is answer question #1. is he is a vegetative state? if so, what would be expected if the plug weren't pulled?

heres what i came up with so far:

1. the electric shock has caused organ damage, due to which the heart is not functioning properly so the bp is fluctuating, and due to that reason he has been placed on life support.

2. "without a durable power of attorney or living will in place, the health care system has no choice but to resuscitate the patient and keep him alive by artificial means unless he is brain dead and saving him is hopeless."

3.

4. health care system

5.

6. as he is on a ventillator..so there are no other options, dnr, dni

7. in my opinion, if the family is not facing a financial disaster and if there are chances for his recovery then they should wait for some more time, dnr, dni

8.

The questions in this case study are those you would cover in a medical ethics class. Have you completed a medical ethics class? If so, then your text book should have the answers for you.

heres what i came up with so far:

1. the electric shock has caused organ damage, due to which the heart is not functioning properly so the bp is fluctuating, and due to that reason he has been placed on life support.

2. "without a durable power of attorney or living will in place, the health care system has no choice but to resuscitate the patient and keep him alive by artificial means unless he is brain dead and saving him is hopeless."

3. can you think of no questions and things you would talk with and ask the family?

4. health care system - this is not true. while the doctor ultimately writes the order to either discontinue life support or not, the family's wishes are taken into consideration.

5. can you not think of the ethical and moral dilemmas here?

6. as he is on a ventillator..so there are no other options, dnr, dni - wrong.

7. in my opinion, if the family is not facing a financial disaster and if there are chances for his recovery then they should wait for some more time, dnr, dni

8. this is why you need to review what the hospital ethics committee does.