In absence of Advanced Directives

[pinksapphire]

Hi, I am in my final 6 weeks of nursing school and am working on preparation sheet for a simulation lab. I am having a difficult time finding information for the final question and am hoping someone can provide assistance. The question is:

"If a patient has no Advanced Directives" and no immediate family available to make a decision regarding his care, what options are available to the healthcare team?"

I found the following information on a website:

If a patient lacks decision-making capacity and there is no person who can be identified as an appropriate surrogate, consultation with the hospital ethics committee is strongly encouraged. When it is decided not to request judicial appointment of a surrogate, withholding or withdrawing life-sustaining treatment is ethically acceptable a each of the following conditions are satisfied: 1) reasonable efforts have been made to identify an individual to serve as a surrogate, and these efforts have been unsuccessful; 2) there is a consensus of the physicians involved in the patient's care that there is no expected benefit of life-sustaining treatment to the patient; and 3) conditions 1 and 2 above have been clearly documented in the patient's chart. in addition to these conditions, when a life-sustaining treatment is going to be withheld or withdrawn for such a patient, consultation with either the hospital ethics committee or a physician who is not otherwise involved in the patient's care is required to confirm the patient's best interests are served in the decision to withhold or withdraw life-sustaining treatment.

Is this how end of life decisions for a patient falling into this category would be handled (in general).

Thanks for your help.

[nurseprnRN, BSN, RN]

There is also the concept of "substituted judgment," which see. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518005/

It says something to the effect of, "This is our best estimate of what this patient would want given the circumstances." It is obviously influenced by the judgment of those making the decision, and is not always ethically defensible.

You also consider the basic, basic requirement for not doing harm-- if we could keep someone "alive" (and I use the term advisedly) for but a few extra hours or days, and he is in pain and suffering (not the same thing-- look that up, too), that would not be ethical.