Thank You For Contacting The Ethics Committee Regarding Mrs. Mitsue Takahashi 's Healthcare Plans

Thank You For Contacting The Ethics Committee Regarding Mrs. Mitsue Takahashi 's Healthcare Plans

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Thank you for contacting the Ethics Committee regarding Mrs. Mitsue Takahashi’s healthcare plans. As you are aware, 83 year old Mrs. Takahashi was recently admitted to the hospital immediately following a stroke. Through looking at her past medical history and running various tests, it was apparent that she suffers from several serious medical complications. Notably, she suffers from dementia which makes it impossible for her to make autonomous decisions concerning her healthcare. Despite poor prognoses from neurology, cardiology, and psychiatry consultations, the patient’s two grandchildren disagree over the next step in their grandmother’s healthcare. You have recommended to the family to have a DNR order written, withhold aggressive cardiac and neurological measures, and to start supportive and palliative care instead. The granddaughter views treatment more as a burden that will only prolong Mrs. Takahashi’s suffering. Meanwhile, the grandson wishes for the medical staff to attempt every medical intervention possible in order to keep his grandmother alive. It is because of this dilemma that we, the ethics committee, believe you have contacted us.

The Ethics Committee has reviewed your behavior and agreed that you have acted in an appropriate manner. Physicians can recommend, but not unilaterally determine, a patient’s do-not-resuscitate order (DNR) status, CPR instructions, or medical treatment. The only exceptions are emergency situations where damage may be irreversible if not addressed immediately. A study published in 2014 by Oshitani, Nagai, and Matsui examined the rationale behind a physician’s decision to propose a DNR for elderly patients with pneumonia. The researchers discovered that the physicians looked at certain...


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...an informed choice. Secondly, the medical team should facilitate the discussion between the grandchildren and understand the family’s dynamics to help determine what Mrs. Takahashi would have wanted. Lastly, if an agreement can not be made between the two grandchildren and Mrs. Takahashi’s wishes cannot be determined, the physicians can enact a time limited trial. Goals can be set under the grandson’s proposed plan. For example, if Mrs. Takahashi can return to the nursing home and continue having some of her happy moments within two weeks, then that method can be continued. Otherwise, a transition can be made in her care plan to her granddaughter’s proposed palliative care. The healthcare team must remain involved and supportive throughout the entire process and accommodate for the needs of the family including costs, alternative options, and any relevant information.

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