Barney says no (Case study)
“Barney Says No!”
Almeda was an eighty-four-year-old woman who lived a retiring life with no family and few friends. She suffered from a disabling stroke three years ago and has been confined to bed in a nursing home. Almeda has lost decisional capacity and left no advance directives. Barney, her long time friend, has been her unofficial substitute decision maker. Almeda has developed a stage IV sacral decubitus, now colonized with multiple resistant staphylococcus areus and pneumonia with heart failure. Now she is on the intensive care unit. For two week, Almeda has been on the ventilator and fed with a gastric feeding tube. During this time, she has been treated with high dose cardiovascular drugs and Vancomycin antibiotic. There has been no progress in the heart failure or pneumonia. Although stoic, Almeda shows clear signs of pain when move about for care. The nurses and attending physicians have approached Barney on the numerous occasions to raise the question about stopping aggressive curative treatment and moving toward palliative care. Barney has always insisted that he sees more potential Almeda’s condition. When asked what the right goal for Almeda ought to be, he answered, “It would be good if she could sit up and watch a little television.” Almeda’s renal function has now become seriously impaired and requires renal dialysis. With the prospect of a dialysis, the nursing staff asked for a meeting with the attending physician and Barney to discuss treatment redirection from curative to palliative care.
Moral Problem
“Whether Barney has autonomy or not?”
Moral Analysis: Move to palliative care
Palliative care is needed by all those suffering from advanced progressive incurable disease. It is provided by relatives or other informal cares and by health care professionals both generalist and specialist. Palliative medicine refers to that contribution to the practice and study of palliative care which is made by doctors. The definition which was
Almeda was an eighty-four-year-old woman who lived a retiring life with no family and few friends. She suffered from a disabling stroke three years ago and has been confined to bed in a nursing home. Almeda has lost decisional capacity and left no advance directives. Barney, her long time friend, has been her unofficial substitute decision maker. Almeda has developed a stage IV sacral decubitus, now colonized with multiple resistant staphylococcus areus and pneumonia with heart failure. Now she is on the intensive care unit. For two week, Almeda has been on the ventilator and fed with a gastric feeding tube. During this time, she has been treated with high dose cardiovascular drugs and Vancomycin antibiotic. There has been no progress in the heart failure or pneumonia. Although stoic, Almeda shows clear signs of pain when move about for care. The nurses and attending physicians have approached Barney on the numerous occasions to raise the question about stopping aggressive curative treatment and moving toward palliative care. Barney has always insisted that he sees more potential Almeda’s condition. When asked what the right goal for Almeda ought to be, he answered, “It would be good if she could sit up and watch a little television.” Almeda’s renal function has now become seriously impaired and requires renal dialysis. With the prospect of a dialysis, the nursing staff asked for a meeting with the attending physician and Barney to discuss treatment redirection from curative to palliative care.
Moral Problem
“Whether Barney has autonomy or not?”
Moral Analysis: Move to palliative care
Palliative care is needed by all those suffering from advanced progressive incurable disease. It is provided by relatives or other informal cares and by health care professionals both generalist and specialist. Palliative medicine refers to that contribution to the practice and study of palliative care which is made by doctors. The definition which was
Bibliography: http://www.utcomchatt.org/docs/biomedethics.pdf Babor, Eddie. Bioethics a Philosophical Journey and a Critical Analysis into the Life Sciences: A guide to Healthcare Providers Second Edition. C & E Publishing, Inc., 2010