Reference no: EM133851088

Question

You are the charge nurse on a skilled nursing unit at the local long-term facility caring for Mrs. Charlotte Boyer, a 91 year-old resident who had a stroke 6 months ago requiring placement in the facility. She requires assistance with hygiene and mobility needs, is unable to feed herself, has difficulty with speech and swallowing, and must be constantly monitored for aspiration. She has recently had an incident of aspiration pneumonia. Prior to this event she lived independently and was active in her community. For the past few days she has been refusing her meals, becoming agitated and angry during feedings. The primary care provider has recommended placement of a PEG tube for enteral feedings to maintain an adequate nutritional status. Her son is in favor of the feeding tube and states, "Not feeding mother is cruel and the tube is the right thing to do. Not feeding mother is almost like killing her. I do not think we should play God." The daughter is ambivalent about the feeding tube in that she is aware that her mother would not have wanted any artificial measures, including a feeding tube, to keep her alive. In addition, she feels that her mother's decision to refuse food indicates an attempt to be in control of her own life. She states, "I think I know how she feels and it's almost like the golden rule - do unto others as you would have them do unto you." The children share the power of attorney and power of healthcare for their mother. They have asked you to help them work through this decision-making process and the daughter states, "We need a tie-breaker, as we are at odds as to what to do."

Review Power of Attorney, 

1. How do you feel about being asked to be a tie-breaker?

2. What will you say to the children?

3. Do you have a legal responsibility?

4. Do you have an ethical responsibility?

5. How does your role as a patient advocate affect this scenario?