Instructions: Read the following case of Alan and answer the questions that follow
Case:
Alan underwent emergency coronary artery by-pass surgery 10 days ago, and since then, his condition has remained critical. He has never completely regained consciousness. Owing to a lung infection, he remains on a ventilator under heavy sedation. In the past week he has developed one complication after another—total body sepsis, a life-threatening arrhythmia, hypertension, and some liver failure — for which he has received a number of drugs. Now he is in kidney failure and requires dialysis.
His family has been at the hospital since Alan’s ordeal began. They have been allowed only short visits twice per shift. The nurse and doctor now inform them of the kidney failure and leave them alone to discuss whether they should consent to dialysis.
Alan’s family knows his prognosis is poor. They also know he would not wish his life to be extended in this way. They believe he has suffered enough, and decide to refuse this dialysis, knowing he will die. They request a meeting with the team to discuss their decision
While visiting Alan a short while later, his wife notices that he is still receiving drugs to maintain his blood pressure, as well as the antibiotics that so far have not improved his condition. Further, the nurse informs her that because Alan’s potassium is elevated, he will be given calcium polystyrene enemas in an attempt to bring it down.
The family is distraught. Together, they gather the courage to tell Alan’s nurse that they do not wish to subject him to these enemas which, if effective in the short term, will only prolong his dying. Further, they insist that the drugs be discontinued, and that they be allowed to remain with him in privacy. Alan’s nurse supports the family’s position and communicates their wishes to the physician on call. The family is permitted to stay with Alan until he dies peacefully a short time later.
Questions:
1. How did this case evolve to the point where Alan’s family needed to advocate on his behalf?
2. How could this situation have been avoided? What process would have resulted in a better outcome for everybody.
3. What rights did Alan and his family have? Were these rights respected?
4. Identify the contradictions in this story.
(Source: Keatings, M. & Smith, O. (2010). Ethical & Legal Issues in Canadian Nursing (3rd ed.) Toronto: Elsevier.)