On Competency and the Right to Deny Care
Patient N.G., while capable of understanding the pain of her situation should be considered mentally competent to decide her own level of care, and permitted to refuse certain medical care. While it could be argued that N.G. was incompetent due to some dementia as described by being disoriented to time, no problem should arise in giving unwanted care unless someone, deemed competent (such as family), demanded she be kept alive. The only problem I can see here is not so much the right to refuse service, but the fact that someone might hold the caretakers and medical director responsible for allowing the patient to die. This is highly unlikely due to her situation, and due to her desire to be left to die.
Patient N.G. is eighty-eight years old, has no known close relatives, has a list of medical ailments, has been in a nursing home for the past three years, and for the past three years has been passively and somewhat actively end her life through dehydration or starvation of fluids. Whenever forced to consume liquids or be fed intravenously, she has struggled and expressed her desire to be left alone and left to die. One could argue however, that the patient was mentally incompetent for several reasons. The first of which is her desire to die or kill herself. This suicidal mindset for one is enough to force treatment on most individuals however, given her situation; it is highly conceivable that most people would want to die at her age, with no friends or family nearby, under the constant pain and multiple medical factors at large in her body. Seemingly the other reason, perhaps more effect in this instance is that she suffers from dementia, unable to fully comprehend what era, decade or time frame she is in. This could be argued to be sad, but unimportant in relation to the fact that the patient does understand how she feels, she does know where she is, if not when, but that whoever she believes may be president at the time, she is tired of living and hurts too much.
I do not fully understand the benefits of keeping this woman alive. What caretaker could have the woman’s best interest in mind if he cannot differentiate the quality of life with quantity of life? The woman has lived a full life, everyone she’s cared about is gone, and she does not have much of a life, if any, for which to go one living. More importantly, what caretaker could think he has her best interest in mind if considers neither her pain in living, nor her desires to be left alone? The only person it would seem at this point who would demand to keep her alive, and from her wishes, is someone who may feel they are responsible for any backlash for the decision, or for the death of the woman.
The only solution I can see, given that the person in charge of her is forcing care upon her for his own protection, is that this person must simply obtain consent from the patient allowing him to discontinue care on her request. If not in this manner, at the very least he could have her sign a written request to stop providing forced care (even if this means she is released from the nursing home). Either way, given that she has no close relatives whom might complain after the fact, there would most likely be no problem. More importantly what happens most often is simply that the person in her state who refuses to be fed intravenously and chooses not to eat or drink as well, is left and allowed to die. No one complains, and everyone understands that given her pain and age it was probably her time to pass on anyway.
As an Emergency Medical Technician I have seen women (more often than men) in very similar situations, and it pains me to see people in such pain. My last living grandparent fears that going to hospitals will result in her death, or them forcing her to stay there under their care until she dies. She would far rather die in her lazy boy in her living room at home, than in a hospital bed or nursing room home. However, she has told me (despite her own dementia of forgetting some of her grandchildren, and seeing spirits around her home), that when she is in pain and asks to die, do not let the hospital nurses or anyone else keep her alive.
My sister, a Certified Nursing Assistant, has worked in hospitals and in nursing homes, and has become friends with many of the sick and dying. She tells me that in her experience they want to be left to die, but never forced to die. All they really want (for most mentally deficient patients) is to have someone like a nurse substitute as a loved one and help them pass on in a warm and caring environment. Like most patients the dying seek the comfort and alleviation of pain, and when the pain is too great, or the cause for living too low to hold out, to be aloud to die peacefully.
Patient N.G. is eighty-eight years old, has no known close relatives, has a list of medical ailments, has been in a nursing home for the past three years, and for the past three years has been passively and somewhat actively end her life through dehydration or starvation of fluids. Whenever forced to consume liquids or be fed intravenously, she has struggled and expressed her desire to be left alone and left to die. One could argue however, that the patient was mentally incompetent for several reasons. The first of which is her desire to die or kill herself. This suicidal mindset for one is enough to force treatment on most individuals however, given her situation; it is highly conceivable that most people would want to die at her age, with no friends or family nearby, under the constant pain and multiple medical factors at large in her body. Seemingly the other reason, perhaps more effect in this instance is that she suffers from dementia, unable to fully comprehend what era, decade or time frame she is in. This could be argued to be sad, but unimportant in relation to the fact that the patient does understand how she feels, she does know where she is, if not when, but that whoever she believes may be president at the time, she is tired of living and hurts too much.
I do not fully understand the benefits of keeping this woman alive. What caretaker could have the woman’s best interest in mind if he cannot differentiate the quality of life with quantity of life? The woman has lived a full life, everyone she’s cared about is gone, and she does not have much of a life, if any, for which to go one living. More importantly, what caretaker could think he has her best interest in mind if considers neither her pain in living, nor her desires to be left alone? The only person it would seem at this point who would demand to keep her alive, and from her wishes, is someone who may feel they are responsible for any backlash for the decision, or for the death of the woman.
The only solution I can see, given that the person in charge of her is forcing care upon her for his own protection, is that this person must simply obtain consent from the patient allowing him to discontinue care on her request. If not in this manner, at the very least he could have her sign a written request to stop providing forced care (even if this means she is released from the nursing home). Either way, given that she has no close relatives whom might complain after the fact, there would most likely be no problem. More importantly what happens most often is simply that the person in her state who refuses to be fed intravenously and chooses not to eat or drink as well, is left and allowed to die. No one complains, and everyone understands that given her pain and age it was probably her time to pass on anyway.
As an Emergency Medical Technician I have seen women (more often than men) in very similar situations, and it pains me to see people in such pain. My last living grandparent fears that going to hospitals will result in her death, or them forcing her to stay there under their care until she dies. She would far rather die in her lazy boy in her living room at home, than in a hospital bed or nursing room home. However, she has told me (despite her own dementia of forgetting some of her grandchildren, and seeing spirits around her home), that when she is in pain and asks to die, do not let the hospital nurses or anyone else keep her alive.
My sister, a Certified Nursing Assistant, has worked in hospitals and in nursing homes, and has become friends with many of the sick and dying. She tells me that in her experience they want to be left to die, but never forced to die. All they really want (for most mentally deficient patients) is to have someone like a nurse substitute as a loved one and help them pass on in a warm and caring environment. Like most patients the dying seek the comfort and alleviation of pain, and when the pain is too great, or the cause for living too low to hold out, to be aloud to die peacefully.