Description
Turning 100 in the ICU
Mr. White turns 100 years old today. Festive balloons float in the corner of his room; a beautiful flower arrangement sits in a basket on a counter in the hallway. The flowers aren’t permitted inside the room, because Mr. White is a patient in the I.C.U. of Metropolitan Hospital. Although he survived surgery two weeks ago for repair of an abdominal aortic aneurysm, he has been unresponsive to stimuli ever since. His prognosis for recovery is poor.
Mr. White was intubated (received a breathing tube) in the O.R. and is still dependent on a ventilator to breathe for him. After approximately 10 days, an ET (endotracheal or oral breathing tube) begins to damage the trachea; for this reason, it can’t be left in place long-term. If the patient cannot be weaned from the ventilator (as is Mr. White’s situation), there are two alternatives.
The first alternative is to extubate the patient (i.e. remove the tube), provide hospice care, and allow the patient to die naturally, usually within minutes to hours.
The second alternative is to insert a tracheostomy tube or “trach” (a breathing tube inserted through the skin of the throat into the trachea). Tracheotomy surgery is a minor procedure that can be performed at the patient’s bedside. The trach can remain in place long-term, and Mr. White can be transferred to Mercy, a long-term acute-care hospital that specializes in the care of ventilator-dependent patients.
Mr. White refused to designate a health care proxy before his surgery, insisting that he was otherwise perfectly healthy and would recover quickly. He has two daughters, both in their 70s. The treatment team has met several times with them to explain the treatment options. Beulah believes that her father should be removed from the ventilator and placed in hospice. Eunice, on the other hand, believes that he should have tracheotomy surgery and then be discharged to Mercy. The team members are divided, and the sisters cannot reach a decision. They are in moral distress, and turn to you, their father’s primary nurse and chair of the hospital ethics committee, for guidance. What will you recommend as the right thing to do for Mr. White?
In your post, include some mention of the principles of nonmaleficence and beneficence, as well as references to Shannon and Kockler’s chapters and the Frontline episode “Being Mortal.”
Reference should come this book ( An introduction to bioethics) fourth edition by Thomas A. Shannan and Nicholas J. kockler.