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Risk Management and End-of-life decision making

You are the new Director of Risk Management at Little Falls Hospital, which is a 450-bed tertiary care facility in a major urban area in the Northeast. The hospital is an integrated health system that provides the full array of inpatient and outpatient services. The hospital enjoys a reputation for quality care in the area.

As the new risk manager, you have been briefed about a patient care case that needs your attention.

* A 45-year-old woman, Lydia, who is currently paralyzed and can only communicate through head nods as a result of a car accident over six months ago.
* The patient is currently on a ventilator for respiratory assistance and receives tube feedings.
* The professionals in the hospital are uncertain as to whether the patient is capable of understanding information and making her own decisions.
* It is reported that the patient has an advance directive, but no one has been able to secure a copy of the document.

You have been asked by Felicia Larue, the hospital CEO, to give a briefing on the patient situation and alternative actions that may be taken by the hospitals to ensure that the rights of the patients are preserved and the risks to the hospital are minimized. Prepare a summary of the important components of this case, the laws which may have an impact on this case, and alternative courses of action that the hospital may pursue to satisfy the parties that are involved with the scenario. The strategies and recommendations should be as specific as possible and include the resources needed for implementation. Your primary text and journal/website research must be used as a reference to support your analysis.

Character #1

Character Details: Mr. Bevins - Patient's Spouse

Script: Lydia and I have been married for four years and I know that she would not want to be kept alive in this fashion. She and I have had many conversations and discussions about end-of-life decisions and living like this would not be her choice. I do not know the whereabouts of the advance directive since she did this prior to our marriage, and my attempts to obtain a copy have failed. I am her guardian and therefore, the decision should be mine.

Character #2

Character Details: Eileen Redfield - The patient's mother

Script: I am Lydia's mother and it hurts me to see my daughter laying there so incapacitated. Ending her life is not the answer. A couple of the physicians have implied that she might get better and live a better life, while others have given me little hope for recovery. A miracle is always possible and I want to give my child every chance she can to live.

Character #3

Character Details: Dr. Bob Pritchard - Patient's Physician

Script: I have been taking care of Lydia for the past 90 days. Although she does demonstrate progress in very small increments, her level of functioning has not significantly improved. This is compounded by the fact that Lydia also suffers from breast cancer--a condition diagnosed and treated successfully before the accident. I am not sure what advice to give the family about the patient's long-term survival.

Solution Preview

Dear student

I recommend that you further investigate the ethical and legal implications that surround end of life decision making.

As Director of risk management you need to make recommendations that can be supported both legally and ethically, and that the duty of care to the patient is upheld. It is therefore essential that you are aware of the legal and ethical consequences of each of the alternative actions. You also need to consider the family and the reputation of the hospital as a quality care provider.

Case Summary and Recommendations

Lydia has been receiving life sustaining support for over six-months. It is thought Lydia is incapacitated but this has not been confirmed. Her husband is her legal guardian, making him the surrogate decision maker and in accord with the New York Health Care Proxy Law, he has the legal right to make decisions on behalf of his wife. In respect of his wife's wishes, Mr Bevan has asked that life sustaining support be withdrawn. However the decision to withdraw active treatment is not supported by Lydia's mother who believes that Lydia has a chance of recovery.

Before the accident Lydia had prepared an advance directive. The advance directive cannot be located, but Lydia has verbally communicated with her husband what her wishes ...

Solution Summary

This solution looks at risk management strategies in relation to end-of-life decisions in a health care setting

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