Physicians usually encounter dilemmas in the course of their profession that requires effective resolution due to ethical, legal, and practical ramifications. The case study shows an 80-year-old man who has been suffering from congestive heart failure for five years. After undergoing a preliminary examination, the physician notes that he needs surgery to save his life. However, the patient states that he wants to die, yet there is no DNR, living will, or advanced directive. In this view, to determine the competence of the patient, as a physician, I would question the patient regarding the nature of expected interventions, prognosis, and why he needs to die. Entwistle, Carter, and McCaffery (2010) argue that clinicians should provide patients with enough information regarding the nature of the interventions and prognosis of their conditions so that they could make informed decisions about their health. In the case study, it appears that the patient is incompetent because he has not gained enough information for him to make an informed decision about his health.
I would base my decision on the incompetence of the patient. Since the patient wants to die, his decision emanates from his incompetence because he does not understand the impact of surgery and the prognosis of his condition. Thus, I consider his wish to die as unreasonable and uninformed decision. Moreover, since the patient is old (80 years), I would consider him as incompetent because age and congestive heart failure have deteriorated his health condition for the last five years.
Concerning surrogate decisions, I would not base my actions on the decision of the wife because it is irrational and unreasonable. The wife has no any medical reason why she is objecting surgery, except personal fears. In contrast, the opinion of the daughter has more weight than that of her mother because she wants to save the life of his father using available medical interventions. In this view, the daughter seems reasonable as she is acting in the best interest of the patient, which is in line with the principle of beneficence. Koppel and Sullivan (2011) assert that when a patient is incompetent, healthcare providers need to consider the decisions of the surrogates so long as they reasonably represent acts of beneficence. Hence, as a physician, I would consider the opinion of the daughter deeply and proceed to perform appropriate surgery to save the life of her father.
To persuade the patient to proceed with the testing and treatment, I would inform him about the importance of the interventions in improving his health condition. Moreover, I would delve into prognosis so that the patient could understand the essence of testing and surgery as critical interventions that could save his life. In essence, I would ensure that my paternalistic actions comply with principles of beneficence and maleficence. If the patient were my patient, I would recommend him to undergo testing and surgery as medical interventions that are critical to improve his condition.
Voluntariness and understanding are two elements that are essential for one to make an informed consent. Voluntariness requires one to give consent without undue persuasion, coercion, or manipulation, while understanding requires one to make informed consent after considering the pros and cons of the consent (Valapour, Kahn, Balley, & Matas, 2011). When dealing with incompetent patients such as children, the elderly, critically ill patients, and people with mental disorders, it is difficult to gain informed consent because they do not have the mental capacity to act voluntarily and understand the details of consent.
References
Entwistle, V., Carter, S., & McCaffery, K. (2010). Supporting Patient Autonomy: The Importance of Clinician-Patient Relationships. Journal General Internal Medicine, 25(7), 741-745.
Koppel, A., & Sullivan, S. (2011). Legal Considerations in End-of-Life Decision-Making in Louisiana. The Ochsner Journal, 11(4), 330-333.
Valapour, M., Kahn, J., Balley, R., & Matas, A. (2011). Assessing Elements of Informed Consent among Donors. Clinical Transplant, 25(2), 185-190.