Communication and Bioethics at the End of Life by Lori A. Roscoe & David P. Schenck

Author:Lori A. Roscoe & David P. Schenck
Language: eng
Format: epub, pdf
Publisher: Springer International Publishing, Cham

4.Advance directives can be helpful under the right circumstances, and ineffective in others. How might advance directives be improved to avoid situations like this?

A Bioethicist Responds

Given the particulars presented in this case, it seems fairly astonishing that AH should end up in the situation she did at the moment of her death. First, the fact that this occurred in the same state as the Schiavo case means, according to Florida State Statutes, that both of AH’s parents should have had equal standing as legal surrogates; furthermore, it occurred less than ten years later. Second, a significant irregularity appears to have taken place on the part of the attorney hired by AH’s mother, one that goes unchallenged. Third, the judge appeared to have been more interested in avoiding a difficult family member and a potentially troubling public relations problem than in acting to do a right and good thing for an incapacitated patient. And, finally, the professionals caring for AH were destined to become frustrated when their combined skills, knowledge, experience and perspectives on situations such as those surrounding AH were effectively “high-jacked” by persons not having benefit of the same.

Admittedly, we do not know who AH might have named as surrogate, or surrogates, in her original advance directive, which the hospice reportedly had lost, so it is possible that her mother could have been named as her only surrogate. Nonetheless, the mother’s determination to contradict AH’s clearly stated oral preferences to her physician, which were corroborated in her advance directive, combined with her own history of schizophrenia, and her having hired an attorney who at one time had represented Terri Schiavo’s parents, are problematic issues from the very beginning. Complicating the situation even further was this attorney’s placement of a note in AH’s medical chart claiming that she had the authority to revoke AH’s advance directive. It is unclear where, in Florida Statutes at any rate, such a claim might be supported, and there is no indication in the case report as to why the judge would accede to this action. Moreover, it is irregular, to say the very least, for anyone outside those charged with direct, or delegated, care of a patient to add something to a patient’s chart absent permission. The remaining description of the court hearing is equally troublesome, raising yet more puzzling questions about the judge’s action, or rather, inaction in this case.

For whatever reason, the judge has chosen the easy way out here. It would appear that she had gleaned enough from the testimony of the medical team that AH would not survive an indefinite period of time, and so she delayed the case for three months, no doubt hoping that AH would succumb in the meantime. She obviously achieved her purpose while also sparing herself having to make any difficult decisions. It demands little imagination to suggest that she might also have thought she would be doing relatively little harm (not least to herself!) in making this choice, especially insofar as AH was in what was described as a persistent vegetative state.

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