FACTS: The patient is a 72 year old man who was to be admitted to the hospital from a private nursing home to have a defective feeding tube replaced through the abdominal wall. The patient has been in a coma, but can breathe on his own, for the past 9 months after a head injury suffered in an auto accident. He has no family except for a brother, age 60, who is his designated Durable Power of Attorney for Health Care but who lives far away and who has visited the patient only on a couple of occasions. Other than this designation, there is no written expression of the patient’s personal desires. The only other relative is a male cousin who lives near by and has visited the patient several times each month. The brother has contacted the patient’s physician and requests that the feeding tube not be replaced and the patient allowed to die peacefully. He stated that he knew his brother would not like to remain in a comatose condition. The physician, with neurology consultation, has related to the brother that the patient may eventually recover to some degree. The cousin has contacted the doctor and informed him that the brother is known to be the beneficiary of the patient’s estate and questions the motives of the brother’s decision. The physician has taken the matter to his hospital’s ethics committee for help in resolution.
THE ISSUE: The ethics of termination of life support for this head injury patient and to what extent should the decisions of the legal surrogate be followed if conflict of interest is suspected.
QUESTION: Should the defective feeding tube not be replaced and patient allowed to die on the request of the legal surrogate? ..Maurice.
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