Informed Consent in Elderly Population
Informed consent on elderly patients can be problematic. In this case an 80-year-old male patient refuses a surgical procedure that can possibly to save his life. During the examination, the patient states that he just wants to die, but there is no DNR or living will document in his chart. The spouse wants to save her husband's life, but is extremely afraid of surgery. The daughter wants to save her father's life under any circumstances.
A physician in a private medical practice sees an 80-year-old male patient complaining of chest pain. The patient has been suffering from congestive heart failure for the past 5 years and has been under his care during this time. The patient's wife and daughter also are present in the examination room. The physician concludes that tests and a possible surgical procedure are necessary, possibly to save the patient's life and sends him to the emergency room (ER) for further studies. During the examination at the ER, the patient states that he just wants to die, refuses any test or treatment. There is no DNR or living will document in his chart. The spouse states that she wants to save her husband's life, but is extremely afraid of surgery. The daughter states that she wants to save her father's life under any circumstances.
(1) What can be done to determine the competence of this patient?
(2) Would the patient's wish to die be part of deciding his competence?
(3) Should the physician base his actions on the wife's possibly irrational fear of surgery?
(4) How deeply should the daughter's opinions be considered?
(5) Should the physician persuade the patient to proceed with testing and treatment without coercion (paternalism)?
(6) What other special population can be difficult to obtain informed consent?
The solution involves discussion of the ethical and legal aspects of informed consent on elderly patients as portrayed in a case of an 80 year old male with history of congestive heart failure (CHF) who refuses a surgery that could possible safe his life. Other aspects to consider are a wife (no age stated) who wants to save her husband but is afraid of surgery, a daughter (no age stated) who wants to save her dad at all cost, the abscence of DNR or a living will, and determination of competence in this population.
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