| Mr. Duffy is 83 years old and is admitted
to rehabilitation four weeks after a right thalamic CVA. As
a result of his stroke, he has dysphagia, dysarthria, and
left hemiplegia and is moderately-severely confused.
When Mr. Duffy pulls out his nasogastric feeding tube,
his physician decides not to re-insert it because of
significant nasal tissue necrosis. The team recommends a
gastrostomy tube because of his high risk for aspiration
and inability to maintain nutrition and hydration with oral
feeding.
Mr. Duffy has a Living Will that states he does not wish
to have his life sustained with a feeding tube. He does not
have a formal Durable Power of Attorney for Healthcare. His
wife has dementia and his two daughters are making
decisions for both parents. They are not sure about his
wishes in this particular circumstance, but report that he
said of a relative who died of cancer, "things went on
too long because of that feeding tube."
After three days, Mr. Duffy is more alert and during a
discussion about tube feedings he says "I' ll go
for the works." His fluctuating alertness level makes
it impossible for him to respond to this question again.
His daughters feel he would not want the tube and suggest
waiting to see if their father' s swallowing will
improve in the next week before making a decision.
Questions to consider:
- Who is the appropriate decision-maker in this
case?
- What options are available to the team?
- Suggest an optimal solution in this case.
Related Readings
Hare, J., Pratt, C., & Nelson, C. (1992). Agreement
between patients and their self-selected surrogates on
difficult medical decisions.
Archives Internal Medicine. 152
(5): 1049-1054.
Tippett, DC & Sugarman, J. (1996). Discussing
advance directives under the patient self-determination
act: A unique opportunity for speech-language pathologists
to help persons with aphasia.
Am. J. SLP. 5
(2): 31-34.
|
Responses:
Annotated Bibliography
|