Reference no: EM133095019

Ms. Jacobs, 84, has lived at The Laurels for 3 years. She has a diagnosis of a past cerebral vascular accident (CVA) with right-sided weakness and bilateral hearing loss. She is alert and oriented, enjoys watching TV and listening to classical music, but rarely participates in group activities. She has three daughters who all visit regularly. When she entered the facility she indicated under the Patient Self-Determination Act papers she signed that she wanted all reasonable measures to be taken to treat any reversible condition.

Each day, Ms. Jacobs gets up with the assistance of one person and performs her morning activities of daily living (ADLs) with minimum aid. She ambulates daily for short distances with her walker and standby assistance.

One Friday, Ms. Jacobs refused her breakfast and lunch, saying she did not feel well, and wanted someone to perform her ADLs. Nurse Casey noticed that her speech was slightly slurred, blood pressure was 130/74, pulse was 84 and regular, respirations were 24 and unbalanced. Ms. Jacobs was alert, oriented to person, place, and time, and showed no other changes in ability to follow commands or ambulate. Dr. Greg was called. He asked the staff to encourage oral intake and to call him if Ms. Jacobs showed any other changes.

On Saturday, Ms. Jacobs had difficulty transferring herself from her bed to her chair and complained of leg weakness. She continued to refuse to eat and drank only small amounts of liquids. Dr. Greg visited, and decided to admit her to the hospital to perform some tests to assess if she had had another CVA. Dr. Greg explained his concerns to Ms. Jacobs and she appeared to understand. However, Ms. Jacobs told Dr. Greg and her daughters, "I don't want to go to the hospital. I am old and tired. Please leave me alone and let me die. I am ready to die." Dr. Greg and Ms. Jacobs's daughters decided to honor her wishes. Dr. Greg then wrote the following orders on her chart:

"Encourage patient to take fluids orally. Do not resuscitate in event of cardiac or respiratory arrest. Do not transport to the hospital. Do not place nasogastric tube or start intravenous fluids."

Many of the staff were confused and angry. A debate among staff ensued as to whether Dr. Greg and Ms. Jacobs's family were correct in following her wishes expressed after her changes in status, and in not transferring her to the hospital.

Is the physician correct? If so, why? If not, why not? Are the confused and angry staff correct? If so, why? If not, why not? Are the daughters correct? If so, why? If not, why not? Is Ms. Jacobs correct? If so, why? If not, why not?