Question

CASE STUDY . . Clinical Quality and Patient Autonomy Ql relates not only to the quality of clinical care provided, but also t autonomy. Mary Elizabeth Wainwright, a lifetime smoker, had lived in citizen residence for 27 years. At age 93, she had outlived her husband, h relatives. She was brought to the ER by ambulance, mentally alert but severely thc and all he Her pulmonary condition had deteriorated, and she had been ventilator d 2 months. She was a favorite on the chronic vent unit, always smiling. Th the staff was that she kept pulling at her endotracheal tube and telling wanted the staff to let her die. Although attempts to wean her from the ventilator failedl h staff continued to try a "slow wean." t of breath. dent for the past nc everyone tha t she The hospital had difficulty finding a chronic vent unit to take Mary because of recenrl shut off the ventilator diagnosed brittle diabetes, severe rheumatoid arthritis, and ischemic card The intern stated to the nursing staff, "This is a futile case. Why not and let nature take its course? The money could be better spent elsewhere. The hospital risk manager was concerned that honoring the patient's wishes might result in that anyone a long-lost relative suing the hospital. The attending physician did not believe would choose to die. "She must be delusional. I won't obey a crazy person's wishes. Confused about what to do, the senior resident calls a member of the ethics committee for advice. Before the ethics committee meets, a member of the committee meets with the patien The patient communicates the following: "I have lived around, watering my plants and talking to my cat. All my friends and relatives have died. M eyesight and hearing are rapidly failing, and my joints hurt from being in bed so long." She stated that she expected more pain in the future, without significant improvement. She did not expect to be taken off the respirator or to walk around her apartment ever again. She had lived long enough and therefore chose to a long life and liked best to walk die. The ethics committee met with the attending physician, resident, intern, and key nursing staff. The committee member who spoke with Mrs. Wainwright provided the patient's rationale and discussed the patient's wishes and her capacity to make a decision of this magnitude. The committee reviewed the concepts of nonmaleficence, beneficence, and autonomy. Options were discussed with emphasis on how to best serve the patient's interests

Answer 1

1.The ethical issues here are

• Patient wants to die as all her family members and relatives have died and she has lived long.This alone cannot make a healthcare providers to nod for the approval to end her life .According to the law it states that a patient can request for death if only going to live for 6 months or less and going to experience pain and no progress,the health-care team always looks into this matter
• As there are no relatives for the patient ,the decision of her to end her life in sound mind due to the debilitating disease and its painful symptoms makes the healthcare team to be in a dilemma. But the ethics committee has paved way for this by knowing the patients wishes.

2.The scenario is acceptable at most part considering her age,prognosis, disease conditions, pain.Her decision has to be respected and agreed.

3.This decision can change if the patient is 18 year old,purely depending on the age and the body's capacity in accepting the treatment. The disease condition can be tried to brought under control with the help f technology and medicine.