Capacity, Choice and Advance Directives
Margot Bentley was a long-time nurse, working mostly with patients with dementia. She was determined not to die a slow, lonely, frightful death like so many of her patients. So she planned ahead. Bentley wrote a living will, one that clearly stated that, when her time came, she did not want heroic measures taken to keep her alive. She also discussed the issue with her children, fully and openly, and they were in agreement….Yet today, the 82-year-old, who is in the final stages of dementia, is being kept “alive” against her wishes and those of her family….
….Here’s what Margot Bentley wrote in her living will, when she was compos mentis: “I direct that I be allowed to die and not be kept alive by artificial means or ‘heroic measures,'” she wrote eight years before her diagnosis. She also specifically stated that her caregivers should dispense “no nourishment or liquids” if she was in a condition where it was clear there was no reasonable chance of recovery….
….Bentley, who lies in bed in a semi-vegetative state, is fed three times a day. A care worker puts a spoonful of puréed food to her lips and she eventually opens her mouth and the food is pushed in; then she swallows, often with difficulty. The family argues that she is doing so by reflex; the health-care institution caring for her argues that it is a demonstration of the will to live.
Case Analysis – using CNA Ethical Framework.
- Individually Reflect on the case and the commentary. Write down your initial thoughts/reactions. Share your thoughts with your team. (Worth 5%)
- Determine who is involved in the case. Name all the parties and their relationship to the patient.
- Describe the issue. What exactly is the problem or issue to be solved?
- Assess the situation. What is the team’s “perceptions” and reflections on the situation – in short form?
- Clarify values. What Ethical Values are involved in this story?
- Identify ethical principles involved in the case. You can use all your reading and resources to name them.
- Clarify legal rules. Are there any laws involved in this story?
- Explore options and alternatives. What are some of the options to solving this problem?
- Decide the course of action.