Physicians face challenges in decision-making whenever a patient reuses treatment. They have to focus on the ethical guidelines and legal requirements before making a decision in response to the patient’s non-compliant nature. This paper looks into the ethical and legal decisions required in a case where a patient refuses to eat.
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The role of the physician, in this case, is to ensure that Ann’s state of wellness is improved. Since she has refused to eat and talk to the health care providers, the only option I find plausible is to involve Frank in trying to persuade her to eat or have a feeding tube. Allowing Ann to starve to death would be equivalent to assisted suicide. My ethical role as a health care provider is to protect life, not to assist its termination (Ribera-Casado, 2015). As a physician, I am required by ethics to respect the will of the patient, but in this case, the requirement to protect life overrides the need to respect the patient’s decision.
The law stipulates that the use of percutaneous endoscopic gastrostomy (PEG) is a procedure that does not require the consent of the patient; hence, physicians have the power to force a patient with eating difficulties to use the feeding pipe. Since it is commonly used for demented patients with eating difficulties, Ann belongs to a group of patients that might require the intervention. However, it is apparent that PEG is normally used for patients in life support, which would imply that Ann’s wish to refuse such treatment would have to be upheld (Ribera-Casado, 2015).
The application of feeding tubes has a complex legal element because it is considered a treatment method; hence, the patient has a right to refuse the application of the intervention. If Ann refuses to have the feeding tube applied to save her life, I would have to comply with her wish (Druml et al., 2016). However, since there is an indication that Ann is not mentally capable of making decisions that are geared toward attaining her best interests, Frank would legally be allowed to make the final decision on the issue. Engaging Frank in the decision to use the PEG is the only available option in this case; hence, I would ask him to discuss with Sarah and make a decision.
Advice to Frank and Sarah
Sarah and Frank should help Ann to realize that her current condition does not qualify as a dire situation where she needs life support. The only issue is that she has refused to eat, and she cannot continue receiving medication without eating. She should attempt eating or allow the physician to apply the PEG, which will enhance the quality of her life and the speed of recovery (Druml et al., 2016). I would advise Frank to use the power granted to him by the law because his wife is not mentally capable to give legal consent on the treatments to be applied. I would also advise Sarah to try to persuade her mother to accept the treatment.
Frank and Sarah should know that they have the power and obligation to save Ann’s life by compelling her to eat or accept the PEG alternative. The ethical considerations require the caregivers to save her life, but the legal requirements give her the power to refuse treatment. However, the ultimate decision on the way forward will be made by Frank and Sarah.
Druml, C., Ballmer, P. E., Druml, W., Oehmichen, F., Shenkin, A., Singer, P.,… Bischoff, S. C. (2016). ESPEN guideline on ethical aspects of artificial nutrition and hydration. Clinical Nutrition, 35(3), 545-556.
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Ribera-Casado, J. M. (2015). Feeding and hydration in terminal stage patients. European Geriatric Medicine, 6(1), 87-90.