What can you say concerning early episodic dementia patients who refuse to be resuscitated?

Question

A patient who is known to forget things and is terminally ill refuses resuscitation, how can ethical principles be related to this?, and how does this relate to legal issues?
Lets talk about autonomy, consent, and other principles such as beneficence, maleficence, utilitarianism etc.
How does this ethical issues affect the nurses who are supposed to work in the best interest of the patient? It could be that the patient is not fully aware of their choices even when it appears that he/she is.

Answer 1

If the patient has signed a consent for non resus then it would need to be respected, hopefully with support from the next of kin;

Answer 2

Anyone can ask not to be resuscitated. My dad has Alzheimer's and my mother and I have discussed it. Basically when he is sick we do the bare minimum--he had a heart attack and we authorized the surgery to put stents in, which was a disaster which we'll never repeat, only to find out a few months later that they probably didn't help him at all.
My dad asks us all the time to kill him. He's always thought that being hooked to up machines was horrible. He has no living will but my mom is his legal representative.
I consider AD to be a terminal illness. People with terminal illnesses who are suffering shouldn't be forced to continue living if they don't want to. My dad might not be in physical pain but his mental anguish is enormous.
Hopefully the medical personnel working with such a patient will respect his wishes.
If you've never see the movie "Wit" about a woman dying of cancer, watch it. It addresses this very thing in one section.

Answer 3

That is why a power of attorney is appointed so they can make those medical decisions for them. The nurses have to follow the legal documentation in the living will or Do Not Resuscitate Order (DNR) Comfort measures are always included in a DNR, antibiotics, pain medications, breathing treatments. The only things withheld are CPR and intubation, in some cases feeding tubes. Sometimes its a sudden onset of dementia, CVA ect.. and the pt does not sign the DNR, generally the pt signs it as they realize that their health is going down hill so they are aware of what they are asking for. Also having been in health care 11yrs the quality of life after having a cardiac arrest in which you survive is really no quality at all for most. They are completely incapacitated. That is no way to live. Comfort measures to make their last days the most comfortable they can be is best and or not resuscitating is advisable.

Answer 4

The legal guideline used is if a patient is capable of understanding the consequences of his decision, then he has capacity to make medical decisions. If someone is able to convince us that he understands that being DNR/DNI may shorten his life and will prevent us from using certain treatments that may be lifesaving should the situation arise, then he can sign his own papers. Sometimes we have to call a psychiatrist to make the tougher calls, it's often not black and white, especially in situations like the one you're describing. Most hospitals have an ethics committee for dealing with issues just like that, and the only rule I can say is that the decision has to be made on a case-by-case basis.

Answer 5

Even though you may suspect that the patient will not remember what she has said and signed you must respect those wishes.
Your primary duty is to relieve pain, and work in the best interest of the patient, therefore you must assume the patient is fully cognisant of all facts unless proof to the contrary is obtained.

Answer 6

This patient can be declared non compus mentis (or something close to this) if the patient is percieved to be by Physicians, altered. This can mean the patient does not know the day/date/time or if he/she see's things that do not exist.

In this case the closest personal relative can be given limited power of attourney.

Consult a Lawyer.