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Right to Die You Decide

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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 In respect of his wife's wishes, Mr Bevan has asked that life sustaining support be withdrawn.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 would be, should she ever find herself in such a situation.
The laws to be taken into account include the New York's Family Health Care Decisions making Act.(FHCDA) and the New York Health Care Proxy Law.
The newly established FHCDA allows for family members to make decisions on behalf of the incapacitated patient, irrespective of whether the patient has signed an advanced directive provided that the surrogate decision maker has either direct knowledge of the patient's wishes or will act in the the patient's best interest. However, in this case, Mr. Bevin is also the appointed guardian, which gives him the right to make decisions on behalf of his wife, including the decision to withdraw or withhold life-sustaining treatment, but this right can only be enacted, once the doctors have made a firm decision that the patient is no longer capable of making decisions for herself.
That Lydia is unable to make decisions for herself has not been confirmed.
It is therefore vital that before any decisions are made with regards to withdrawing life support, that the physician determines whether or not Lydia is in fact incapacitated and that treatment is futile. However if Lydia should be able to make decisions, then it is she that should give informed consent for any procedure or withdrawal of treatment. Once it has been determined that Lydia is incapacitated and that treatment is futile, there are three options to be considered.
1) Comply with Mr. Bevin's request that his wife's wishes are fulfilled, and stop all active treatment. The risk of withdrawing life-sustaining treatment is that Lydia may die, and any chance of recovery will be thwarted. The benefits are that Lydia's wishes are respected and fulfilled and the decision is in keeping with legislation. The resources needed to implement this decision include hospital staff, counseling services, debriefing sessions with family members and staff
2) Continue with active treatment indefinitely - this is what Lydia's mother would want, but is not congruent with Lydia's wishes, as expressed by Mr. Bevin. The risks are that Lydia may not recover, her suffering is prolonged, and her right to a dignified death is not honored. The benefits are that Lydia's mother is given hope, and that Lydia is given more time with her family. The resources needed to implement this decision include long term delivery of life support.
3) Continue with active treatment for a specified time and then review. If no improvement then discontinue active treatment. The risks are that when the specified time is over, the same issues will arise. The benefits are that
The decision must be unbiased and reflect as accurately as possible, the decision that Mrs. Bevin herself would have made, if she was able to do so. As surrogate decision maker, Mr. Bevin has the responsibility to ensure that Lydia's wishes are respected, irrespective of what others, including himself and Lydia's mother, would want for her. It is the hospital's responsibility to ensure that Mr. Bevin can make an informed decision and that the decision does not go against Mrs. Bevin's best interest and values.
References
Rich, B (2002) The ethics of surrogate decision making, Western Journal of Medicine, March 176(2): 127-129, retrieved June 2, 2011, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071685/
Swindler, R. (2010) New York's Family Health Care Decisions making Act. The legal and political background, key provisions and emerging issues. http://www.nysba.org/Content/NavigationMenu/PublicResources/FamilyHealthCareDecisionsActInformationCenter/Background.pdf
Health care proxy, appointing your health care proxy in New York State http://www.health.state.ny.us/forms/doh-1430.pdf
The Health Care Proxy Law: A Guidebook for Health Care Professionals, Department of Health
http://www.health.ny.gov/regulations/task_force/health_care_proxy/guidebook/

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