CLINICAL CASE FOR DISCUSSION
Mrs. Sanchez
Lawrence P. Ulrich, Ph.D.
Lawrence.Ulrich@notes.udayton.edu


Some Issues Raised:

Mrs. Sanchez is 78 years old and lives with her daughter, Maria. She has two other children who live in different cities. On March 23 Mrs. Sanchez, after a long history of cardiovascular disease which has rendered her progressively compromised, suffered a cardiac arrest at home. She was resuscitated by the EMS and brought to the hospital where she rallied somewhat but remained decisionally incapacitated. Three days after admission she suffered a CVA and was placed on a ventilator. Both the pulmonary and neurological consults determined that she would remain ventilator dependent, would continue to deteriorate, and would probably never regain decisional capacity. Maria demanded that her mother remain a full code and that "everything" be done to preserve her mother's life and attempt to restore her to health. The other two children came to the hospital and in separate conversations indicated to the nursing staff that they understood that Mrs. Sanchez had signed a living will three years previously. Maria had not informed the nursing staff of this  document and its existence remained only a rumor among the team caring for Mrs. Sanchez.

Some Discussion Questions:

1. How would the Patient Self-Determination Act help to address this issue?
2. What would you do if there had been a living will and Maria had refused to produce it?
3. What should be done if the living will refusing life-sustaining treatments were to come to light and Maria continued to demand that "everything" be done.
4. What guidance does the Ohio advance directive law give for this situation?
5. What is happening to Mrs. Sanchez's dignity in the current situation?
6. How might the various ethical systems and frameworks give some guidance to resolve this problem?
7. How do the principles of autonomy, beneficence, justice, and fidelity figure into this case? Which principle(s) should govern the decisions made in this case?
8. What strategies would you implement to bring this case to a resolution which maximizes the well-being of the patient?