Question

1. Discuss one or two other sets of circumstances that might justify overriding the instructions detailed in a patient’s advance directive.

2. Provide an ethical analysis supporting the decision to override the patient’s right of autonomy or discuss why such a course of action would not be supported from the perspective of biomedical ethics.

Please include your reference for my review. Thank you

Answer 1

1. An 70 year-old man with Alzheimer’s disease who enjoys walking in nursing home’s garden with his walker has fallen and broken his hip.

An advance directive signed by the patient states a preference for “comfort measures only,” and specifically states that he does not want to be transferred to the hospital.

The physician states that surgery would provide long-term pain relief and the chance to maintain some mobility.

2. To resolve this an ethical analysis would include :- l

Is the clinical situation an emergency?

In view of the patient’s values and goals, how likely will the benefits of the intervention outweigh the burdens?

How well does the advance directive fit the situation at hand?

How much leeway does the patient provide the surrogate for overriding the advance directive?

How well does the surrogate represent the patient’s best interests?

Based on these analysis it is ethically appropriate for the physician and patient relatives to override the patient’s previously stated wishes in her advance directive and transfer her to the hospital for surgery.