A 101-year-old woman is admitted to your hospital. She is in a persistent vegetative state after a fall with bleeding into the brain. She is also an unstable diabetic in early renal failure requiring initiation of dialysis. The attending physician believes dialysis would be unnecessarily stressful to the patient and would be unlikely to improve her condition appreciably. He has discussed with her three daughters the futility of further interventions. One daughter is insisting that all measures be taken to prolong her mother’s life, another is insisting that it is only prolonging her death and wants the physician to order a DNR, and the third is indecisive. As hospital administrator on call you are consulted on the situation.
Answer the following:
What further information do you need to assess the situation?
What motivations might the daughters have for their positions?
What are the ethical dilemmas in this situation?
What steps might you take to resolve the situation?
What are potential consequences if you follow one daughter’s instructions over another?
What legal protections could the hospital seek?