C.J., a 26-yr-old patient in a permanent vegetative state, is diagnosed
with her 15th bladder infection. As her home care nurse, you must
determine whether to seek antibiotics for this infection. The family
members have expressed a concern that no heroic measures be used
to extend the life of their daughter and sister. However, they have
been unwilling to stop providing enteral nutrition through a
gastrostomy tube. Should antibiotics be withheld?
Ethical/Legal Points for Consideration
• Patients in a persistent vegetative state do not recover.
• The main legal issue here is who has the legal right to refuse or
consent to treatment for this incapacitated patient. You need to
know if a guardian has been appointed by the court or if her
parents retain a form of guardianship to make health care
decisions for her.
• You need to know when the vegetative state began; that is, did
the patient ever have the right to consent having reached the age
of majority as a competent adult or did the vegetative state begin
while she was a minor? If the patient did become a competent
adult before the vegetative state, did she ever express any
preference for quality-of-life and end-of-life decision making?
• The courts have widespread legal precedents for accepting the
decision of the patient’s guardian or parents or the patient’s
clearly expressed preferences for quality-of-life decision making.
• Life-sustaining treatment is any treatment that serves to prolong
life without reversing the underlying medical condition. Lifesustaining treatment may include, but is not limited to,
mechanical ventilation, renal dialysis, chemotherapy, antibiotics,
and artificial nutrition and hydration.
• There is no ethical distinction between withdrawing and
withholding life-sustaining treatment. If there is not adequate
evidence of the incompetent patient’s preferences and values, the
decision should be based on the best interests of the patient (i.e.,
what outcome will most likely promote the patient’s well-being).
1. How would you approach C.J.’s family?
2. What are your feelings about providing nutrition, hydration,
and treatments that will prolong life in a patient for whom
there is no hope of recovery?
3. What options are available to the family for the care of their
daughter once a decision is made about withholding
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