Ethical Decision Making, Case Study Example

In this case study, the patient has indicated in the directive that she wanted “no surgery, heart-lung resuscitation, antibiotics, dialysis, mechanical ventilator or tube feeding.” This was the patient’s wishes before she became unable to make decisions for herself. Morally, most people in the medical field want to do whatever they can in order to save or life, or prolong a life; however, caretakers must take into account the wishes of the patient. In this particular case, the patient has become unable to feed herself; however, the patient is able to actually consume the food and only needs assistance with placing the food in her mouth. It seems that the director of nursing feels that having to feed the individual for two hours per day is not efficient for the helpers. This is where morality comes into play. The patient can still eat food and consume the food with assistance; therefore, she technically doesn’t need a feeding tube. In addition, if the nurse is concerned about the amount of time put towards one patient, what would be the difference in time with a feeding tube? According to the Bureau of Outreach Services, (1), persons who have feeding tubes require special attention to ensure both health and safety. Feeding tubes can increase the risk for aspiration, pneumonia or other health problems. In addition, there are many procedures that nurses have to follow for individuals with feeding tubes. For instance, individuals with feeding tubes require the same aide or nurse; instructions and management of the feeding tube must be continuous and must be supervised by a registered nurse.

In the case study, it was the director of nursing that recommended that the feeding tube be used on the patient. The moral and social concerns of these recommendations should be evaluated. (Bureau of Quality Improvement Services 1) Does the director of nursing have the authority to recommend a feeding tube directly to the patient? Are there orders from the residing physician approving these recommendations? Again, it seemed that the director of nursing thought the aides were spending too much on one patient. Does that mean that less time will be given to the patient when a feeding tube is established? Is there a moral or concern in this recommendation? People could argue this recommendation for two reasons. For one, the patient did not want a feeding tube. Second, the patient is still able to swallow food and eat food from her mouth with the help of aide. For some individuals, it could also be argued that this person is not getting the treatment they deserve. Although their bodies have deteriorated, they should not be treated any differently and should be respected as a human being. The amount of time it takes to feed an individual does not seem valuable enough to justify a feeding tube.

There are many issues concerned with feeding tubes. Physicians refer to the feeding tube as percutaneous endoscopic gastrostomy (PEG). This requires a routine surgery that is safe; however, there are legal and ethical questions. The main concern is that PEG doesn’t require the consent of the individual having the procedure. Essentially, is forced feeding. There is a matter of ethics to the medical benefits of the PEG in elderly patients, which are the highest percentage of individuals with a PEG. Some studies have shown an increased death rate in elderly patients within one month of receiving the PEG. The patient’s family should be aware of the medical goals and moral goals of this procedure. (Milkes 1) The legal issue with the feeding tube is that the American Medical Association and the Supreme Court have agreed that artificial nutrition is a form of medical treatment and can be legally refused; however, it also states that competent patients have the legal right to refuse treatment with feeding tubes. (Milkes 2) In this particular case, the patient has already assigned her wishes for medical treatment in the advance directive. Therefore, can that written document be legally used in this particular case? The advance directive is a written instruction for future health care decisions in the event that an individual is no longer able to speak for themselves. (Family Caregiver Alliance) The laws regarding these documents vary from state to state.

The laws and personal decisions of the patient should also be accepted. Some institutions think that the nutrition and hydration must be provided to the patient; however, if the patient was written document that they do not want to be artificially feed, their wishes should be respected. (Smith-LaMacchia) In this case, the patient can still eat with the help of an aide; therefore the ethical thing to do in this situation would be to continue to feed the patient with the help of an aide. The patient should not be left to die without any food unless the patient is completely incapable of consuming food with the help of an aide or a nurse.

It is recommended that if there are any families involved in this type of situation that they educate themselves on the topic. There are resources that they family can turn to in order to receive every moral, ethical and legal advice in regard to implanting a feeding tube into their loved one. It may be extremely hard for the loved one to accept the ethical principle in respect to their loved one and they may insist on the feeding tube because they are grieving the possible loss of their loved one. In this case, therefore, the feeding tube should not be implemented and the patient should continue to receive care until they can no longer feed with help. The only negative consequence to this plan is that the aides/nurses need to assist two hours a day in the feeding. The positive consequence to this plan is that the individual’s wishes for no feeding tube has been met and they can continue as planned. In addition, the patient’s daughter will feel less stress and anxiety because her mother is receiving the planned treatment and did not have to undergo a surgery for the feeding tube.

Works Cited

Bureau of Quality Improvement Services. Outreach Services of Indiana. Health & Safety: Eternal Feedings. Web. Retrieved from: http://www.in.gov/fssa/files/FS_enteral_feeding_best_practices_20091118.pdf

Bioethics Decision-Making Model. Web. Retrieved from: http://www.pbs.org/newshour/extra/teachers/lessonplans/science/chimera_decision.pdf.

Family Caregiver Alliance. California Advance Health Care Directive. Web. Retrieved from: http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=429.

Milkes, D.E. Ph.D. “Tube Feeding” — Right or Wrong: The Medical, Legal and Ethical Issues”. Web. Retrieved from: http://www.thedoctorwillseeyounow.com/content/aging/art2071.html.

Smith-LaMacchia, R. Ethics of Tube Feeding. (2007). Advance for Nurses. Vol. 9 •Issue 24•Page 38 . Web. Retrieved from: http://nursing.advanceweb.com/article/ethics-of-tube-feeding-1.aspx.