Ethics in LTC Administration

Long-term and end of life care can present legal and ethical challenges. The ability to navigate these, to the benefit of the patient, family, facility, and your own career, is a critical skill in long-LTC administration. Using the case study offered, answering the questions presented within the scenario. Your response should be 3-5 pages in length, not counting a cover page, abstract, and references, in APA format Case Study: End of Life Care and the Family An 80-year-old man in a coma, with no hope of recovery, is admitted to an LTC facility where you are employed as a healthcare administrator. The man has not prepared an advance directive such as a living will or healthcare proxy. The patient’s religion does not require artificial nutrition or hydration, and all members of the patient’s family agree that the patient does not want to die with tubes attached to him. The attending physician has met with the family prior to completing the PLST form to determine what orders he will write. The physician informs the family that the patient will die in a few days without having a feeding tube inserted for water and liquid food. The feeding tube my keep him alive for a number of years. If there is no feeding tube for hydration, his death might be painful or uncomfortable. The physician and the facility’s religious affiliation would prefer to treat the patient with artificial hydration via a feeding tube rather than do nothing. The family has refused the feeding tube, and the physician has referred the matter to the institution’s ethics committee. Case Study Questions 1. As a member of the healthcare ethics committee, explore to following options: a. Transfer the patient to an inpatient hospice, where he can die a natural death and any pain will be treated with medications. b. Keep the patient at your facility and go to court for a an order to insert a feeding tube under the contention that, without the feeding tube, he will die. 2. Discuss how keeping the patient at your healthcare institution or having this physician treat the patient would violate the religious stance of both the organization and the physician. 3. How is this discussion changed if the patient has both a living will and a healthcare proxy that specifically state he does not want a feeding tube and he wishes his death to be peaceful, even if that means using medication to keep him comfortable at the expense of shortening his life? Reference King, E.L. in McSweney-Feld, M.H., & Oetien, R., (eds.) (2012). Dimensions of Long-Term Care Management – An Introduction. Chicago: Health Administration Press. pp. 229-230.