: Jon is a 42-year-old male who survived a devastating car accident when he was 25 years old. He lives in a skilled nursing facility where he receives full assistance with activities of daily living (ADL). He is in a "semi-vegetative" state, as documented by one physician. He has no skilled care needs.
Jon's mother was appointed his legal guardian in 1996, one year after his accident. He has three sisters and one brother. For 17 years, Jon's mother visited the facility at least twice daily to feed her son. He would eat all his food and did not have problems chewing or swallowing. Jon was a healthy looking adult male and he had been medically stable for many years.
Six weeks ago, Jon's mother died of a heart attack. Since then, Jon has deteriorated; he will not take food or drink when offered it by the certified nursing assistants (CNAs). He lost 20 pounds and was sent to the hospital, where he was treated with antibiotics for a diagnosis of pneumonia. After successful treatment of the pneumonia and hydration with IV fluids, Jon was sent back to the nursing facility but did not resume eating or drinking except for intermittent small bites.
The resident's attending physician approached the siblings about sending Jon back to the hospital for placement of a gastrostomy tube (a tube surgically inserted into the stomach) to allow for nourishment. Two siblings wish to consent to the surgical procedure. The other two siblings are in agreement that they do not want a feeding tube intervention. They want to allow their brother "to go" and are advocating keeping him at the nursing facility to die.
The resident has no advance directives. The facility administrator advises you that one of the siblings is threatening to obtain a court order prohibiting the surgical insertion of a gastrostomy (feeding) tube. What actions will you take?
Respond to the following:
1. Who has the legal right to make decisions on behalf of a patient? Is this an end-of-life decision based on your state law? ·
2. What is healthcare power of attorney? How does it apply to the patient? 3. How do ethical principles apply to your reasoning? ·
3. What policies and procedures would you implement in your hospital administration and information tracking to ensure that the number of incidences like this is minimized in the future?
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