discussion questions 506

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Discussion questions

Directions: When answering with references, please include the doi or permalink when referencing on the reference page. Each of these are individual questions, so please answer individually.

1. What predictors determine if patients are mentally competent to make their own decisions? How could a patient’s decision be affected in situations where the decisions do not appear to make sense?

2. What are the differences between a permanent vegetative state and a coma? How do these differences affect the ethical choices faced by the family and caregivers of the patient? What importance should the patient’s own wishes have? How would the presence of a living will affect the decision?

3. A baby is born with anencephaly, or absence of the entire brain above the brainstem. The brainstem is intact, which means that the baby can breathe and have a heartbeat and blood pressure, but there is no chance for any human brain function or cognition, due to this birth defect. The health care team begins to educate the mother, since children with this deficit generally die shortly after birth. However, the mother is devoutly religious, and her minister has told her that if she prays hard enough to God, that God will work a miracle and her baby’s brain will heal itself. She is insistent that all possible care be given to her baby, including a months-long stay in the ICU, constant care by a caregiver, regular brain scans, and other expensive modalities. The hospital, finding her adamant, asks the court for guardianship of the baby, with the medical plan to provide only maintenance care with no life-prolonging techniques until the baby dies. What are the ethical issues are involved? How do the principles of autonomy, beneficence, nonmalfeasance, and justice manifest themselves? If you were called as an ethical consultant, what would you do/recommend?

4. A 94-year-old woman is admitted to your hospital with dehydration, trouble breathing, and possible kidney failure. She is clearly in advanced Alzheimer’s, weighs about 95 pounds, and shows multiple bruises on her body. She cannot talk. Her caregiver attributes the bruises to a blood disorder that reduces clotting. What are your thoughts about this situation? What kind of investigation would you conduct? What actions would you take to be in compliance with ethical principles?

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