Biomedical ethics

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Biomedical ethics

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1Arctic-Stranger
Août 15, 2007, 4:28 pm

This came up in our hospital ethics committee the other day. It came as a case study, and not an actual case in the hospital. I want to hear your responses, and will comment on it later.

A retired Doctor was volunteering as a hospice worker. His client was an elderly woman with several children and grandchildren, who was dying of cancer. Around Christmas she stopped eating, and went into a coma. Per her wishes, the family had stopped hydrating her.

The daughter asked the Volunteer Doc how long Mother had. The doctor told her that, given her lack of food, and now water, she could expect to live a week or less.

The daughter asked if there was any way to keep her alive until the new year, without feeding tubes or a reinserting a central line for hydration. The doc asked why and the daughter said that the new tax laws go into effect Jan I, and the inheritence tax would going through some radical changes, and less of her resources would go to the government, and more to her family, if she made it until Jan 1.

"She was a practical woman," the daughter said. "She would have wanted her family to be well provided for."

Any thoughts?

2teelgee
Août 15, 2007, 4:39 pm

Was the patient at home? or in a hospital or care center?

3Arctic-Stranger
Août 15, 2007, 4:58 pm

She was in the nursing home where she had lived for the last five years or so.

4reading_fox
Août 15, 2007, 5:22 pm

Interesting. .
As I've posted on the other threads:
My first thought was "if there was any way to keep her alive until the new year, without feeding tubes or a reinserting a central line for hydration" is still respecting the Gran's wishes, and hence iffy but OK with me. After all it would still be a reasonable request even if there was no money involved at all.

I would be far more concerned if the Gran's stated wish had been contradicted, but to wish to extend her life is ethically fair by my rules. That this subsequently provides benefit to the family isn't troubling.

I personally would probably have not want to hang around any longer than I had to, but in a coma there is no evidence that you notice.

5teelgee
Août 15, 2007, 5:36 pm

I'd feel more comfortable with the decision if it was clear that the patient really wanted that. It is clear she was ready to die. Not that I'd want to deprive the family of money (or give the war machine more of it) - but something about it feels selfish to me.

And really, was it in the doctor's power to keep her alive without life supporting measures?

6januaryw
Août 16, 2007, 10:43 am

I am a social worker and when considering ethics I tend to ask myself "what is best for the client?" and "what is best for the lives of others (family members, invested others...). If keeping grandma alive for a few extra weeks means a new lung for Timmy, go for it! If it means a fancy new car for the daugter... hmmm, it seems gran's rights trump hers.
Another thing (a passing thought really)... It seems to me that the client (patient, whatever) is more than likely blissfully unaware of anything including bodily signals of hunger and pain (I am not a doctor, so I don't KNOW that, but without brain activity it stands to reason that you wouldn't). My friend was in a coma for 3 months and when he woke up he didn't remember anything from the coma (he was one of those rare ones that woke up with no lasting brain injury)

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