Ethical IssuesOrder No. 357724No. of pages: 6Writer: 653A 65 year old woman with advanced COPD is admitted to ICU post respiratory arrest. She has been diagnosed with bi-basal pneumonia and is intubated and fully ventilated. While you are documenting her belongings you discover a recently signed copy of an Advanced Directive in which she has stated that in the event that her condition deteriorates she does not want active treatment to be performed, in particular intubation and ventilation. What implications does finding this Advanced Directive have for the care of your patient?
Discuss briefly. Chronic Obstructive Pulmonary Disease (COPD) is a disease of the lungs which makes it very difficult for the patient to breathe. COPD is of two kinds –Chronic bronchitis, where mucous blocks the chief airways within the lungs causing swelling for a long and indefinite period. Emphysema, where air sacs are destroyed resulting in lung disease. COPD mostly occurs in smokers, but even passive smokers who inhale dust and smoke on a regular basis are likely targets for severe bronchitis. Air pollution and other allergies could worsen the situation.
Inhalation of gases or other fumes in the absence of proper ventilation leads to bronchitis. Some of the symptoms seen in patients suffering from bronchitis are Wheezing, shortness of breath, cough with mucus which at times could have blood streaks, fatigue, headache and swelling of feet and ankles. Our patient of 65 years of age is diagnosed with advanced COPD after being examined by the Physician with a stethoscope. Her condition was critical as she has been diagnosed with bi-basal pneumonia and so is intubated and completely ventilated in the ICU.
Though lung disease is not completely curable, yet treatment can be given to the patient to help him breathe differently in order to stay active. In order to begin the treatment for our patient, the patient’s condition was assessed through blood samples, CT scans, BP and checking her breathing rate. However, when her belongings were being documented, an Advanced Directive was found stating that in the event of her condition worsening, active treatment should be terminated. Advanced Directives are legal documents pertaining to the reference of treatment for the patient when not in a position to take medical decisions by themselves.
In such a scenario, the patient appoints or designates a surrogate decision maker also called a ‘Heath Care Proxy’ in her place. In the case of our patient, the Advanced Directive stated that in event of her disease being irreversible and incurable and her physician is sure that the disease is terminal, then the life sustaining measures such as intubation and ventilation should be discontinued immediately. ‘Chronic critical illness is a devastating syndrome for which treatment offers limited clinical benefits but imposes heavy burdens on patients, families, clinicians and the health care system. ’ (Camhi, S., Mercado, A., Morrison, R., Qingling, M., Platt, D., August, G., & Nelson, J.
(2009). Considering the scenario of our patient who is in a critical condition and understanding that her disease cannot be cured, my role as a patient advocate puts me in a very responsible position to see that everything is carried out according to the patient’s desire. Before beginning any treatment, a letter of consent is obtained from the patient because she would be in no position to take any kind of decisions because her condition was quite critical.