A new resident of the long-term care facility, Mrs. Henley, suffers from advanced dementia. Her limitations are significant, but it is clear that she still enjoys sitting outside near the aviary. She also still seems to enjoy her meals, although she sometimes needs prompting. One afternoon, her daughter, who is also Mrs. Henley’s DPOA, visits and is outraged to see one of the CNAs helping Mrs. Henley eat lunch. A meeting with the Director of Nursing followed immediately where Mrs. Henley’s daughter insisted that her mother was quite clear about not wanting to be fed if she was unable to do it herself. The nursing director explained that her mother rather enjoys her meals, but the daughter insisted that as the DPOA, she has a moral obligation to carry forward mother’s previously expressed wishes. The nursing director reaches out to you, the chair of the ethics committee, for guidance. What recommendations should you offer?-
Expert Solution Preview
Introduction:
In this scenario, as the chair of the ethics committee, you have been approached by the nursing director of a long-term care facility for guidance concerning a conflict between a resident’s daughter, who is also her Durable Power of Attorney (DPOA), and the facility’s staff. The conflict arises from the resident’s advanced dementia and her expressed wishes regarding feeding. As a medical professor responsible for evaluating and advising medical college students, it is essential to consider the ethical implications and potential recommendations in this situation.
Answer:
When providing recommendations in this case, it is crucial to prioritize the well-being and autonomy of the resident while considering the legal obligations and duty of care towards the resident by the nursing staff. Based on the given information, several considerations and recommendations can be made:
1. Review the legal and ethical framework: Firstly, it is essential to review the applicable local and state laws regarding decision-making rights and the role of DPOA. Familiarize yourself with any legal obligations and guidelines that govern treatment decisions for individuals with advanced dementia.
2. Assess the resident’s capacity: Evaluate the resident’s capacity to make decisions regarding her own care. Although she has advanced dementia, her ability to enjoy sitting outside near the aviary and partake in meals with assistance suggests she may still have some awareness and enjoyment. It is crucial to assess her cognitive capabilities, preferences, and understanding of the consequences of her choices.
3. Consult with the resident’s healthcare team: Engage the interdisciplinary healthcare team involved in the resident’s care, including physicians, nursing staff, and social workers. Collaboration among these professionals can provide a comprehensive understanding of the resident’s condition, prognosis, and preferences.
4. Communicate with the resident’s DPOA: Facilitate a transparent and open conversation with the resident’s daughter, who serves as the DPOA. Clarify the role and responsibilities associated with the DPOA and discuss the resident’s current condition, care plan, and the potential benefits and risks associated with honoring the resident’s previously expressed wishes.
5. Seek a consensus: Encourage the resident’s daughter and the nursing director to engage in respectful dialogue to navigate the conflict effectively. The goal should be to find a common understanding that respects the resident’s autonomy while balancing her well-being, safety, and quality of life.
6. Consider shared decision-making: If possible, encourage shared decision-making between the resident, her daughter, and the healthcare team. This approach acknowledges the resident’s preferences while ensuring expert medical advice and input. Constructing a care plan together can strike a balance between autonomy and responsible decision-making.
7. Document and revisit decisions: Ensure that all decisions made are well-documented, including the rationale behind them. Regularly review and reassess the resident’s preferences and health status to ensure that the care plan remains aligned with her best interests and current wishes.
8. Ethical considerations: Finally, emphasize the ethical principles of beneficence (acting in the resident’s best interest), autonomy (respecting her previously expressed wishes), and non-maleficence (avoiding harm). Balancing these principles while providing compassionate care should guide the decision-making process.
Conclusion:
As the chair of the ethics committee, it is essential to approach this situation by considering the resident’s autonomy, best interests, and legal obligations towards the DPOA. Collaborating with the healthcare team, facilitating open communication, and striving for shared decision-making can help resolve the conflict and ensure that the resident’s care aligns with her wishes and well-being. Regular reassessment and documentation are crucial to address any potential changes in the resident’s condition or preferences.
