perez_yariangelis_futilecare

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Cleveland State University *

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Medicine

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Apr 3, 2024

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Kangaroo Demands for Futile Care Suzanne Grimes, a registered nurse, was assigned to care for Mr. Desmond, a 67-year-old man who had developed serious issues due to prolonged mechanical ventilation. He has chronic obstructive lung disease and a condition that causes the right side of his heart to fail. Several days ago, his physicians had decided that his trachea could not be repaired. Now they discovered that he was also suffering from sepsis —when an infection you already have triggers a chain reaction throughout your body, potentially affecting numerous organ systems. After discussing Mr. Desmond’s prognosis with his physician, his family had agreed to discontinue treatment. Mr. Desmond was now semicomatose and incapable of participating in this critical decision. The plan was to make Mr. Desmond as comfortable as possible until his inevitable death from sepsis and respiratory failure. During the morning, Mr. Desmond was visited by his oldest daughter who lived thousands of miles away and had not seen her father for several years. She was visibly alarmed by Mr. Desmond’s condition and by the fact that no treatment was being carried out for his declining physical condition. After conferring with the rest of the family, she announced that the family would like to try an alternative treatment for Mr. Desmond. They called the physician and requested that massive doses of vitamins be given to him. The physician agreed to their request. He then called Miss Grimes and asked her to begin instituting massive intravenous vitamin therapy. Miss Grimes protested the use of this form of therapy in the care of an inevitably dying patient. She consulted her supervisor. The supervisor agreed with the physician and the family. “I don’t understand why you are protesting about vitamins,” the supervisor said. “It won’t take much of your time to administer them, it won’t cost the family a lot of money; and it might help them cope with their father’s imminent death,” she told Miss Grimes. “Besides, vitamins won’t hurt Mr. Desmond. He won’t notice them because he is dying anyway. So why the fuss?” Miss Grimes still disagreed with the plan. She argued, “We are giving the family false hopes and we are setting a precedent for family requests for any treatment on dying patients.” According to Miss Grimes, it was not so much the cost of the requested therapy as the fact that a family could make requests of nursing staff that were of no proven benefit to the dying patient.

What is your reaction to this situation? Is this an example of futile care? Why or why not? Should the hospital listen to Miss Grimes or should they go through with the vitamin “treatment”? In my opinion, it is futile because it is a treatment that cannot prevent the patient's death in the near future. Is it fair that families can request these kinds of interventions? ● If so, where’s the line in terms of treatments that should be allowed to be requested and treatments that aren’t allowed? ● If not, why not, and who determines what kinds of care are futile or not? I feel like they should go with the family because they might feel calmer that he is taking something rather than nothing but vitamins are vital for human life we need a certain amount of intake in order to be healthy. DNR? William MacArthur was a 74-year-old male who had been a widower for six years after a long, very happy marriage. He had had a long career as a business executive running a financially successful printing business. He now suffered from end-state renal disease. He had been on dialysis for four years and tolerated it well. Now, however, his disease had progressed to the point that he needed a blood transfusion to survive. He said he wanted to live, but he was a Jehovah's Witness and was a blood refuser. He had had cardiac arrest twice and had been resuscitated. Dr. Edmund Harvey, the attending physician, is morally uncomfortable with Mr. MacArthur’s refusal of the blood. He know he could save his life with a simple transfusion with very little risk or discomfort, but he understands the patient’s right of refusal and accepts that his patient may refuse even if it will mean certain, rapid death. He asks the patient to accept do-not-attempt- resuscitation status on grounds that there is no further treatment he had to offer the patient. Mr. MacArthur refuses to accept the DNR status, saying that he wants to live a long as possible. He realizes that the repeated resuscitations will be a burden and that they will likely fail within a short time.

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