to the OP,
In my Bio-Medical ethics course we spent two weeks analyzing issues about advance directives. Philosophers like Dworkin, Thomson, and McMahan have published great papers (you can find them in pubmed) and provide analysis on cases like the following which was taken from the Journal of Law, Healthcare and Ethics:
Daniel is a 90-year-old man who has recently been admitted to a short-term, in-hospital nursing facility for the elderly because he has been exhibiting signs of dementia along with behavior problems. Daniel's dementia has been leading to difficulties with eating and drinking. He is unable to swallow food or drink without getting them into his lungs. Daniel is in good health otherwise and has no terminal diseases and seems relatively happy. His behavior problems have been easily controlled with medication and he enjoys watching TV, reading (more or less) the newspaper, and talking to people. By all accounts he is relatively happy and content with his surroundings, except for his eating problems. The doctors have decided that the only way to feed Daniel effectively is to insert a feeding tube into his stomach.
Several years ago, Daniel signed a living will indicating that nothing extraordinary should be done to keep him alive if he were ever in such a state that he could not competently consent to treatment. This living will apparently precludes the insertion of a feeding tube. The doctors, in consultation with Daniel's family, have decided that he will not be given nutrition and hydration since they feel this would violate the intent of his living will. Daniel has not been given food and water for several days, although he has constantly complained of being hungry and has asked why he hasn't been given any food. He cannot currently remember having signed a living will and legally lacks the competence to change such a document. He does not, however, currently wish to starve to death and has repeatedly expressed the desire to stay alive, even if it means being intubated, although it is certainly unclear whether he can understand what being intubated would entail.
Daniel's family and HCPs are thus faced with the decision of whether to intubate him or allow him to die. At t1, a presumably competent person signed a living will generally forbidding such a procedure. At t2, a seemingly incompetent patient appears to want the procedure, although it does not appear that he fully understands what it entails, nor does he presumably understand why it will help him not feel hungry any more. The patient at t2 does seem to be enjoying his life because by all accounts he is relatively happy most of the time, even though his cognitive capacities are severely limited. His family, who are typically called upon to make his healthcare decisions for him, wish to refuse the procedure.
Should Daniel be intubated?
BTW, take the mean comments with a grain of salt
. Pre-allo forum can be like that.
