In the presented case study Ann, a 77-year old patient with moderately advanced Alzheimer’s disease is transferred to a hospital with pneumonia and given intravenous antibiotics. The patient’s condition is getting better, yet she starts to refuse to talk and rejects food. To insert a feeding tube, her physician contacts Ann’s husband Frank and her daughter Sarah who need to make a decision.
The ethical side of this situation is rather complicated. Ann is an incompetent patient since she does not talk and cannot express her own desire concerning her case. Her husband remembers a conversation they had earlier, when Ann’s condition used to be much better, the patient shared her thoughts about the breathing machine. Ann decided that if there was no chance of survival, she should not be attached to the machine. The family wonders if the tube equals the machine and if forcing treatment on Ann would contradict her wish. In this case, Ann clearly has a chance to survive. Ethically, the patient’s family has the right to refuse medical treatment including a feeding tube in case if the quality of maintained life of a patient is insufficient or if life support prolongs the patient’s sufferings. The first registered example of such situation is the case of Karen Ann Quinlan who was in an irreversible coma. In 1976, to obtain the right to stop Karen Ann’s life support her parents had to go through multiple trials (History of Karen Ann Quinlan and the Memorial Foundation, 2013).
Legally, the feeding tube is equal to breathing machine and all other forms of treatment and can be refused by a competent patient or the family of an incompetent patient. This decision is in power ever since the case of Nancy Cruzan, whose situation became the center of debates concerning the right to die in 1990 (Lewin, 1990). Out of all states of America only Missouri (where Nancy Cruzan’s case took place) and New York demand that the family of the patient presents “clear and convincing” evidence that if the patient were competent of making such decision, they would refuse artificial nutrition (Mikes, 2015). Yet, in case of Ann, the 77-year old patient who is still conscious, the family has no right to leave her to starve to death and neither do the doctors treating her. Since Ann’s pneumonia is successfully halted by the antibiotics, there is a chance that her state could improve and this is why her case does not fit into the quality versus quantity of life dilemma.
Speaking with Ann’s husband and daughter I am obliged to provide them with complete information about their rights and options. I would start with explaining Ann’s condition and the fact that the treatment with antibiotics has helped to stop her pneumonia from developing. I would also explain the equality of all kinds of medical treatment (including the breathing machine and feeding tube) and the patient’s right to refuse them. I would explain that since Ann is incompetent, the decision lies upon her family. I would state that a conversation with Ann qualifies as an evidence of her desire to refuse treatment even though it was not documented. At the same time, I would emphasize that Ann clearly stated that she did not want to be attached to a machine if there was no chance of survival and explain that leaving Ann to starve would take away her chances of survival, while the tube provides the patient with such chance. Finally, I would let the family know that feeding tube only helps the patients receive nutrients, but does not cure them from existing conditions. After that I would explain the procedure of tube insertion and possible risks.
Reference List
History of Karen Ann Quinlan and the Memorial Foundation. (2013). Karen Ann Quinlan Memorial Foundation. Web.
Lewin, T. (1990). Nancy Cruzan Dies, Outlived by a Debate over the Right to Die. Web.
Mikes, D. E. (2015). “Tube Feeding” — Right or Wrong: The Medical, Legal and Ethical Issues. Web.