Keeping in mind our more extensive case analysis set of instructions, answer questions 1 & 2 from the case. Respond to at least one comment of your classmates.
Present the problem: A 59 yr old male who has pancreatic cancer decides that he wants to sign a "Do not resuscitate" form and doesn't want anymore treatment. However, when he begins to experience internal bleeding, he asks the doctors for assistance. Should the physicians go off of his initial decision, or should they follow through with his request now?
1. I feel like the most appropriate response in this situation is to administer care to him if he requests it. If he is concious enough to let a Doctor know that he wants care for his internal bleeding, then the doctors should treat him. Thats a scary thought to me--someone begging for assistance or health care and being denied. 2. Sometimes you act completely different in a situation when it is actually occuring than you would have originally planned. I think the doctors should be guided by the decision that they tell you at the moment. If they're concious enoug to voice an opinion, you should obey that opinion.
What if the patient changes their mind every other day. When they are stable they dont want the care but as soon as they have a problem they want all the care they can get. After so many times of them changing their mind youre going to have to make a decision and stick with it.
John H is a 59 year old male diagnosed with pancreatic cancer. If he should go into cardiac arrest, he has requested a DNR. Later, when he has severe internal bleeding he requests that something be done. His two physicians disagree on whether or not to try and stop the bleeding because of his previously recorded DNR. One says they should adhere to the DNR and the other believes that John H's current wishes take precedence. 1) The most appropriate response to this situation would be to attend to John H's desire for something to be done. He is not unconscious; his competence is said to be unclear thus it cannot be assumed that he is unaware of his choices. Also, he has not gone into cardiac arrest so the situation is different than that of the recorded DNR. 2) So long as the request made of the patient is not at odds with their overall welfare, those caring for him should do their best to listen to what the patient wants when they are making requests different than what they had previously stated. A person may make a decision such as a DNR, but when the time comes and they are in physical need, they may decide to change their mind. They are then physically in that situation and their caregivers should do their best to respond to those requests, as they take precedence over previous decisions.
I agree that the request is very different from that of a DNR, and I agree with you overall. The physical need of the second situation is different from that of the first and requires different decisions and must be handled differently, in my opinion. However, if John is dying, do you think that the request to treat the interal bleeding is unnecessary and burdensome since he will die from the pancreatic cancer regardless?
I think the situation depends on if the doctors determine whether or not he will die regardless of any treatment he receives. It is certainly possible that he will die even if he is treated, and in such a case the physicians should anesthetize the patient as appropriate to make his death as painless and comfortable as possible.
1. I think the Doctor should always abide to what John is requesting. It seems that John's earlier request of stopping treatment was more related to his treatment for his cancer, which is known to have undesirable side effects. Therefore, I can see a reason why John would want to stop that specific treatment. However, since the bleeding is a different circumstance, possibly unrelated to his cancer, he should be given treatment as he asks. It's stated that his competence is unclear, however I believe he is conscious enough to understand he is asking for help. The most appropriate response for the doctor is to help John immediately.
2. I think the request should be further evaluated if it's completely out of ordinary, unless it involves saving/continuing their life. Relating to John's case, his request for treatment seemed unexpected, but should have been honored because it included saving his life. In a health care position, you are required to make the patient as comfortable as possible and adhere to their requests and wishes, especially when they are close to their death.
Why do say that it is only the requests that involve saving/continuing their lives that should not be further evaluated? If their decision on that should be taken on face value why should requests completely out of the ordinary not involving saving/continuing their lives be subject to further evaluation?
1. I think that the two doctors should disregard John H's earlier wishes. It states that the level of his competency cannot be determined. This does not necessarily mean that he is unable to determine what treatment he wants. He very well could comprehend the situation and have decided that he does want treatment at this point in time. Because it is unknown how competent John H is then I believe that the doctors should proceed as if he is until they have something that proves that he isn't.
2. I think that those caring for a patient should listen to what the patient is saying at the present moment unless it is clear that they are in some way not competent enough to make a major decision. So long as the patient seems competent then the care givers should listen to their wishes. Prior decisions should be looked at as a guide for if the patient cannot make their wishes known at the present moment. They should in no way take precedent over the patient's new wishes if they are still able to make competent decisions for themselves.
1. I think the doctors should place precedence on the patient's most recent decision. Whether the patient is competent or not can be called into question, but I see it as a greater moral loss to end the life of a patient who wanted to live rather than continue the life of one who did not. Since his actual opinion on the matter can be questioned, it is best to go with the latest information and attempt to stop the bleeding.
2. As long as it is not clear the patient's decision making is impaired, precedence should be placed on the patient's latest decisions, regardless of prior ones already set down. It is certainly possible a patient underestimated their intent to live or the level of pain they would be in otherwise.
I completely agree. People can make rash decisions if they are tired or stressed. They can also change their mind once they had time to think over what they requested. The latest request should be respected if that's what the patient wants.
The appropriate response in this situation is to assume that John H. now wishes to receive additional treatment. It is unknown whether or not John H. has full control over his mind at this point but if he does to ignore his plea for help is to place our decisions on matters of his health over his own. Therefore to not take away control of that decision aid must be rendered to John H. to acknowledge his right to make his own decisions even if his plea for help was indeed misinterpreted and he did not intend to ask for his internal bleeding to be stopped. If a patient in great pain or close to death makes a decisions that seems at odds with a decision made when they were full autonomous the family should respect the the wish they feel to be in the best interest of the patient's health. Strong pain and death can often change a persons mindset and cause them to rethink important decisions so if their is a chance that they are of sound mind their decisions should be respected if they are intended to heal the body. The reason why I say their decision should not necessary be respected as well if they are in pain or close to death is it could be a spur of the moment decision not really intended. For example, if a child falls and scraps their knee a parent will swab it, apply ointment, and bandage it. This is understood to be the right thing to do in order to prevent infection and it is only proper to ignore the additional pain inflicting on the child because it is for their benefit. However, when the same parent who just bandaged the child's knee gets the same wound and do not wish the same treatment should that decision be respected? Does a decision based upon the pain being experiencied override the benefits of the treatment made when not under the influence of that pain?
I agree. We are unaware of the patient's mental capacity but no matter the circumstances the patient's wish should be fulfilled. The situation changes and therefor the patient has the right to change their mind.
1. Although John originally requested a DNR, I think it is the doctors' jobs to facilitate John's most recent desires. Although it states that John's competency is unclear, it does not state that he is not competent. Therefore, in my opinion, John is able to make his own decisions about his own treatment choices. Stopping treatment for the pancreatic cancer is understandable- the treatment is burdensome and costly. However, treatment for the internal bleeding is different because it could be completely unrelated and painful, and thus, to minimize John's suffering, the internal bleeding must be treated. 2. As long as the decisions that John makes don't negatively affect his welfare, his wishes should be honored. Thinking about a situation and making a decision for the future and actually being in a situation and being forced to make a decision are two very different things, and the decision can change from when a person is just contemplating it to when they must actually choose.
1. I think the most appropriate response in this situation would be to honor the “to do something” request and to precede over the DNR. It is not fully known if John H’s competency is still as trustworthy with his latter request, as with the initial request. But the request in the midst should be honored. To me however, these requests deal with two different situations, in the DNR situation he would have already been “dead” and he doesn’t want to come back. In the second situation he would be slowly, painfully dying due to the massive blood loss. So in the event of internal bleeding, the best (moral) response would be to honor the latter request. 2. I think that as long as the patient is deemed competent, precedence should be given to the most recent wishes. Whilst in a painful situation, a patient is very likely to change his/her mind in order to find some relief.
What if it is unknown if the patient is competent enough to make an important decision? Should the doctors proceed with the patients wishes as if they were competent or should they evaluate further to come to a decision as to how competent the patient is?
1). I believe that the most appropriate response in this case would be to give him treatment, even though he requested to have no further treatment. At the time he made the made the request, he might have just said that out of anger and frustration. If the doctor has the proper treatment to save someone's life, then I think they should go ahead and do it. 2). If the patient is clear on what he or she wants, then doctors should go ahead and respect that request. If the patient changes their mind and is not in a clear state of mind, then doctors should take into consideration past requests of the patient, and also decide what is best for the patient while minimizing pain and suffering.
1. The most appropriate response in this situation is do what the patient wants, even though this decision is going against he decisions in the past. I say this because when a patient is on their death bed i think that we should do whatever they ask and also whatever makes them the most comfortable. 2. The current request should guide those who are caring for him. If he is conscience he should be able to decide how he is taken care of, not somebody else.
Although I agree with your opinion, what if the patient is not entirely competent? Should the doctors or the ones caring for that person still adhere to what they say and ask for?
1. I believe that because we don’t know for sure whether John H. is competent or not, measures should be taken by Dr. W and Dr. R to stop his internal bleeding. Although earlier John wished for no further treatment, he may very well be competent in this state, and deserves to be treated as such. John’s doctors should take his request seriously, and use whatever means necessary to treat him. I myself can’t imagine a doctor standing passively by as a patient, such as John H., begs for treatment.
2. Even though a near death patient may not be fully autonomous, his/her request at this time should be fulfilled. If the patient is conscious and giving these orders, I see no reason why they should be ignored simply because these orders contradict a previous request. No one is fully prepared for their own death and the complications that may precede it. So, it does not seem to me out of the ordinary that a patient like John H. would want his doctors to save him.
If he is full aware of the situation, I believe the physicians should abide his decision. People are allowed to change their minds, especially with something so significant such as that. You may have a set decision already made, but when the time comes and you are able to change your mind, you might and that should be okay. I would feel such guilt if I were the doctor who decided to not perform life saving methods on him just because of what the patient stated originally, even though he was asking for it currently. If it’s the patient’s wish, then it should be respected.
1. If the patient is requesting assistance, it is the job of the caregivers to do as he wishes. Because he is in such a high stress situation he may not know what the right decision is and he may feel the need to change his mind. The doctors should abide by his request and do as he asks. 2.If it is evident that the patient's mental abilities are still fully intact, the physicians should do as he wishes. A doctor should always fulfill a patients wish if they ptient is competent and if the needs can be met.
I believe that the doctor should help him. He may have decided to give up before, but he may have changed his mind and decided to live again. No one should be denied the right to live even if they said they didn't want to live before. The doctor should always do what the patient wants as long as it in in the best interest for the patient. If the patient knows what they are asking for and it is good for them, the doctor should do whatever he can to give the patient what he wants.
1. I believe that the most appropriate response would be to stop the internal bleeding, if possible. The doctor isn't sure if John is competent or not, so he should do as John asks since he could in fact be competent.
2. This is a tricky question. Personally, I think that if the patient is competent, his/her most recent request should be the one that determines what is to be done. But if the patient is not competent, then perhaps their initial request should be the one that determines what is to be done.
1 the most appropriate response is to let him die he made the decision while he was conscious in a stable state of mind and now that he is in pain he is not in a clear state of mind 2 i believe that if the patient is competent that his decision is the one that applies and the one that he made was while he was not in pain
1. The appropriate response is to treat John H. Morally it would be wrong to let him die after he recanted his previous statement. He wants to be saved in the present time and its the job of the care give to give care to patients in need. 2. If the patient is not in a stable mind state the care giver should first contact the patients next of kin. If that is a dead in then the care giver should go ahead and give the treatment to the patient and once the patient is stable they should ask again if they want to continue with the first request or the last and after that whichever decision is made go with that no matter what.
I agree that the patient's next of kin should be contacted in this type of situation, but the final decision should not be left up to them. In some cases the next of kin might not be very close to the patient and possibly doesn't have a clue what the patient's wishes are.
1. The appropriate response is to do something to stop John's internal bleeding. Even though he previously stated that he did not want to be resuscitated he has a change of heart when he starts to experience severe pain. The doctors are obligated to abide by the patient's wish and do something in order to stop the internal bleeding. Especially in this situation where time is of the essence to save his life. 2. The request that precedes the patient's original request should be the one guiding those caring for them. People change their minds all the time, so it shouldn't come as a surprise if they go back on what they previously said. Even if their mental state is questionable it's better not to take the chance with their life on the line.
Present the problem: A 59 yr old male who has pancreatic cancer decides that he wants to sign a "Do not resuscitate" form and doesn't want anymore treatment. However, when he begins to experience internal bleeding, he asks the doctors for assistance. Should the physicians go off of his initial decision, or should they follow through with his request now?
ReplyDelete1. I feel like the most appropriate response in this situation is to administer care to him if he requests it. If he is concious enough to let a Doctor know that he wants care for his internal bleeding, then the doctors should treat him. Thats a scary thought to me--someone begging for assistance or health care and being denied.
2. Sometimes you act completely different in a situation when it is actually occuring than you would have originally planned. I think the doctors should be guided by the decision that they tell you at the moment. If they're concious enoug to voice an opinion, you should obey that opinion.
what if they are no conscience and do not have any family members to make the decision for them, what should doctors do then?
Deletewhat if he is not in the right mind from the pain
DeleteWhat if the patient changes their mind every other day. When they are stable they dont want the care but as soon as they have a problem they want all the care they can get. After so many times of them changing their mind youre going to have to make a decision and stick with it.
DeleteJohn H is a 59 year old male diagnosed with pancreatic cancer. If he should go into cardiac arrest, he has requested a DNR. Later, when he has severe internal bleeding he requests that something be done. His two physicians disagree on whether or not to try and stop the bleeding because of his previously recorded DNR. One says they should adhere to the DNR and the other believes that John H's current wishes take precedence.
ReplyDelete1)
The most appropriate response to this situation would be to attend to John H's desire for something to be done. He is not unconscious; his competence is said to be unclear thus it cannot be assumed that he is unaware of his choices. Also, he has not gone into cardiac arrest so the situation is different than that of the recorded DNR.
2)
So long as the request made of the patient is not at odds with their overall welfare, those caring for him should do their best to listen to what the patient wants when they are making requests different than what they had previously stated. A person may make a decision such as a DNR, but when the time comes and they are in physical need, they may decide to change their mind. They are then physically in that situation and their caregivers should do their best to respond to those requests, as they take precedence over previous decisions.
I agree that the request is very different from that of a DNR, and I agree with you overall. The physical need of the second situation is different from that of the first and requires different decisions and must be handled differently, in my opinion. However, if John is dying, do you think that the request to treat the interal bleeding is unnecessary and burdensome since he will die from the pancreatic cancer regardless?
DeleteI think the situation depends on if the doctors determine whether or not he will die regardless of any treatment he receives. It is certainly possible that he will die even if he is treated, and in such a case the physicians should anesthetize the patient as appropriate to make his death as painless and comfortable as possible.
Delete1. I think the Doctor should always abide to what John is requesting. It seems that John's earlier request of stopping treatment was more related to his treatment for his cancer, which is known to have undesirable side effects. Therefore, I can see a reason why John would want to stop that specific treatment. However, since the bleeding is a different circumstance, possibly unrelated to his cancer, he should be given treatment as he asks. It's stated that his competence is unclear, however I believe he is conscious enough to understand he is asking for help. The most appropriate response for the doctor is to help John immediately.
ReplyDelete2. I think the request should be further evaluated if it's completely out of ordinary, unless it involves saving/continuing their life. Relating to John's case, his request for treatment seemed unexpected, but should have been honored because it included saving his life.
In a health care position, you are required to make the patient as comfortable as possible and adhere to their requests and wishes, especially when they are close to their death.
Why do say that it is only the requests that involve saving/continuing their lives that should not be further evaluated? If their decision on that should be taken on face value why should requests completely out of the ordinary not involving saving/continuing their lives be subject to further evaluation?
Delete1. I think that the two doctors should disregard John H's earlier wishes. It states that the level of his competency cannot be determined. This does not necessarily mean that he is unable to determine what treatment he wants. He very well could comprehend the situation and have decided that he does want treatment at this point in time. Because it is unknown how competent John H is then I believe that the doctors should proceed as if he is until they have something that proves that he isn't.
ReplyDelete2. I think that those caring for a patient should listen to what the patient is saying at the present moment unless it is clear that they are in some way not competent enough to make a major decision. So long as the patient seems competent then the care givers should listen to their wishes. Prior decisions should be looked at as a guide for if the patient cannot make their wishes known at the present moment. They should in no way take precedent over the patient's new wishes if they are still able to make competent decisions for themselves.
1. I think the doctors should place precedence on the patient's most recent decision. Whether the patient is competent or not can be called into question, but I see it as a greater moral loss to end the life of a patient who wanted to live rather than continue the life of one who did not. Since his actual opinion on the matter can be questioned, it is best to go with the latest information and attempt to stop the bleeding.
ReplyDelete2. As long as it is not clear the patient's decision making is impaired, precedence should be placed on the patient's latest decisions, regardless of prior ones already set down. It is certainly possible a patient underestimated their intent to live or the level of pain they would be in otherwise.
I completely agree. People can make rash decisions if they are tired or stressed. They can also change their mind once they had time to think over what they requested. The latest request should be respected if that's what the patient wants.
DeleteThe appropriate response in this situation is to assume that John H. now wishes to receive additional treatment. It is unknown whether or not John H. has full control over his mind at this point but if he does to ignore his plea for help is to place our decisions on matters of his health over his own. Therefore to not take away control of that decision aid must be rendered to John H. to acknowledge his right to make his own decisions even if his plea for help was indeed misinterpreted and he did not intend to ask for his internal bleeding to be stopped.
ReplyDeleteIf a patient in great pain or close to death makes a decisions that seems at odds with a decision made when they were full autonomous the family should respect the the wish they feel to be in the best interest of the patient's health. Strong pain and death can often change a persons mindset and cause them to rethink important decisions so if their is a chance that they are of sound mind their decisions should be respected if they are intended to heal the body. The reason why I say their decision should not necessary be respected as well if they are in pain or close to death is it could be a spur of the moment decision not really intended. For example, if a child falls and scraps their knee a parent will swab it, apply ointment, and bandage it. This is understood to be the right thing to do in order to prevent infection and it is only proper to ignore the additional pain inflicting on the child because it is for their benefit. However, when the same parent who just bandaged the child's knee gets the same wound and do not wish the same treatment should that decision be respected? Does a decision based upon the pain being experiencied override the benefits of the treatment made when not under the influence of that pain?
I agree. We are unaware of the patient's mental capacity but no matter the circumstances the patient's wish should be fulfilled. The situation changes and therefor the patient has the right to change their mind.
Delete1. Although John originally requested a DNR, I think it is the doctors' jobs to facilitate John's most recent desires. Although it states that John's competency is unclear, it does not state that he is not competent. Therefore, in my opinion, John is able to make his own decisions about his own treatment choices. Stopping treatment for the pancreatic cancer is understandable- the treatment is burdensome and costly. However, treatment for the internal bleeding is different because it could be completely unrelated and painful, and thus, to minimize John's suffering, the internal bleeding must be treated.
ReplyDelete2. As long as the decisions that John makes don't negatively affect his welfare, his wishes should be honored. Thinking about a situation and making a decision for the future and actually being in a situation and being forced to make a decision are two very different things, and the decision can change from when a person is just contemplating it to when they must actually choose.
What if a decision John were to make did affect his welfare negatively? Should the physicians follow John's wishes, or refuse to do so?
Delete1. I think the most appropriate response in this situation would be to honor the “to do something” request and to precede over the DNR. It is not fully known if John H’s competency is still as trustworthy with his latter request, as with the initial request. But the request in the midst should be honored. To me however, these requests deal with two different situations, in the DNR situation he would have already been “dead” and he doesn’t want to come back. In the second situation he would be slowly, painfully dying due to the massive blood loss. So in the event of internal bleeding, the best (moral) response would be to honor the latter request.
ReplyDelete2. I think that as long as the patient is deemed competent, precedence should be given to the most recent wishes. Whilst in a painful situation, a patient is very likely to change his/her mind in order to find some relief.
What if it is unknown if the patient is competent enough to make an important decision? Should the doctors proceed with the patients wishes as if they were competent or should they evaluate further to come to a decision as to how competent the patient is?
Delete1). I believe that the most appropriate response in this case would be to give him treatment, even though he requested to have no further treatment. At the time he made the made the request, he might have just said that out of anger and frustration. If the doctor has the proper treatment to save someone's life, then I think they should go ahead and do it.
ReplyDelete2). If the patient is clear on what he or she wants, then doctors should go ahead and respect that request. If the patient changes their mind and is not in a clear state of mind, then doctors should take into consideration past requests of the patient, and also decide what is best for the patient while minimizing pain and suffering.
1. The most appropriate response in this situation is do what the patient wants, even though this decision is going against he decisions in the past. I say this because when a patient is on their death bed i think that we should do whatever they ask and also whatever makes them the most comfortable.
ReplyDelete2. The current request should guide those who are caring for him. If he is conscience he should be able to decide how he is taken care of, not somebody else.
Although I agree with your opinion, what if the patient is not entirely competent? Should the doctors or the ones caring for that person still adhere to what they say and ask for?
Delete1. I believe that because we don’t know for sure whether John H. is competent or not, measures should be taken by Dr. W and Dr. R to stop his internal bleeding. Although earlier John wished for no further treatment, he may very well be competent in this state, and deserves to be treated as such. John’s doctors should take his request seriously, and use whatever means necessary to treat him. I myself can’t imagine a doctor standing passively by as a patient, such as John H., begs for treatment.
ReplyDelete2. Even though a near death patient may not be fully autonomous, his/her request at this time should be fulfilled. If the patient is conscious and giving these orders, I see no reason why they should be ignored simply because these orders contradict a previous request. No one is fully prepared for their own death and the complications that may precede it. So, it does not seem to me out of the ordinary that a patient like John H. would want his doctors to save him.
If he is full aware of the situation, I believe the physicians should abide his decision. People are allowed to change their minds, especially with something so significant such as that. You may have a set decision already made, but when the time comes and you are able to change your mind, you might and that should be okay. I would feel such guilt if I were the doctor who decided to not perform life saving methods on him just because of what the patient stated originally, even though he was asking for it currently. If it’s the patient’s wish, then it should be respected.
ReplyDelete1. If the patient is requesting assistance, it is the job of the caregivers to do as he wishes. Because he is in such a high stress situation he may not know what the right decision is and he may feel the need to change his mind. The doctors should abide by his request and do as he asks.
ReplyDelete2.If it is evident that the patient's mental abilities are still fully intact, the physicians should do as he wishes. A doctor should always fulfill a patients wish if they ptient is competent and if the needs can be met.
I believe that the doctor should help him. He may have decided to give up before, but he may have changed his mind and decided to live again. No one should be denied the right to live even if they said they didn't want to live before.
ReplyDeleteThe doctor should always do what the patient wants as long as it in in the best interest for the patient. If the patient knows what they are asking for and it is good for them, the doctor should do whatever he can to give the patient what he wants.
1. I believe that the most appropriate response would be to stop the internal bleeding, if possible. The doctor isn't sure if John is competent or not, so he should do as John asks since he could in fact be competent.
ReplyDelete2. This is a tricky question. Personally, I think that if the patient is competent, his/her most recent request should be the one that determines what is to be done. But if the patient is not competent, then perhaps their initial request should be the one that determines what is to be done.
1 the most appropriate response is to let him die he made the decision while he was conscious in a stable state of mind and now that he is in pain he is not in a clear state of mind
ReplyDelete2 i believe that if the patient is competent that his decision is the one that applies and the one that he made was while he was not in pain
1. The appropriate response is to treat John H. Morally it would be wrong to let him die after he recanted his previous statement. He wants to be saved in the present time and its the job of the care give to give care to patients in need.
ReplyDelete2. If the patient is not in a stable mind state the care giver should first contact the patients next of kin. If that is a dead in then the care giver should go ahead and give the treatment to the patient and once the patient is stable they should ask again if they want to continue with the first request or the last and after that whichever decision is made go with that no matter what.
I agree that the patient's next of kin should be contacted in this type of situation, but the final decision should not be left up to them. In some cases the next of kin might not be very close to the patient and possibly doesn't have a clue what the patient's wishes are.
Delete1. The appropriate response is to do something to stop John's internal bleeding. Even though he previously stated that he did not want to be resuscitated he has a change of heart when he starts to experience severe pain. The doctors are obligated to abide by the patient's wish and do something in order to stop the internal bleeding. Especially in this situation where time is of the essence to save his life.
ReplyDelete2. The request that precedes the patient's original request should be the one guiding those caring for them. People change their minds all the time, so it shouldn't come as a surprise if they go back on what they previously said. Even if their mental state is questionable it's better not to take the chance with their life on the line.