Nursing 408: Professional Issues
Western Kentucky University
Dr. Lisa Proctor
Our clinic takes care of the nursing home in our community. A couple of the patients in the nursing home are a wards of the state. In being a ward of the state the physician is legally obligated to use all available means necessary to keep the patient alive. One patient in particular has suffered for many years from the complications of dementia, diabetes, and severe immobility. On the last admission to the hospital the patient had a very low albumin and it was determined that the patient was not receiving proper nutrition. In previous cases I have encountered where the patient was not eating well, the physician gave the patient and family the choice of starting tube feeding. As a ward of the state the patient from the nursing home facility was not given the option. Patients that are wards of the state cannot have an advance directive. The ethical dilemma that presents itself for me as a nurse is that no consideration is given to the person's quality of life when they are a ward of the state. Starting tube feeding in certain situations is not in the best interest of the patient (Potack & Chokhavatia, 2008). Individuals with irreversible and debilitating diseases, such as dementia, need priority placed on caring, rather than attempting to cure (Byrd, 2004). Extending the length of life without considering the quality of life may not be the most ethical choice. A patient that is a ward of the state does not have the right to decline medical care. If a patient is near death and has multiple medical conditions putting them on tube feedings could prolong the suffering of the patient (Byrd, 2004). Recent studies performed by Weddle and colleagues have shown feeding tubes to be ineffective in preventing malnutrition, preventing pressure sores or improving healing, preventing aspiration, improving functional status, or... [continues]
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