Healthcare Management – End of Life Issues


Writing Assignment #4

Case Summary

At 87, Brian N., an active hiker and outdoor enthusiast, was diagnosed with

Stage III bladder cancer that had spread to his lymph nodes, pelvis and stomach

lining. Although he had lived at home by himself, his condition deteriorated quickly,

requiring the assistance of a home health aide in bathing, dressing and eating. In a

matter of a few weeks, he lost several pounds and was not able to walk or feed himself

without assistance. Nevertheless, a visiting nurse from hospice found him to be

cooperative, capable of sitting in a chair, alert and interactive with his surroundings.

On one occasion, he was found unresponsive and was rushed by ambulance to

the Jefferson County Hospital Emergency Department, where he was resuscitated and

admitted for further evaluation. There, he was seen by his primary care physician, his

urologist and oncologist who agreed that his conditioned had worsened significantly,

could not be treated medically or surgically, and that transfer to an assisted living

community was the only alternative. His oncologist advised him that although his

condition was otherwise fairly stable, insertion of an intravenous feeding tube was

necessary as a temporary measure before his transfer to preserve his life and prevent

dehydration and a painful death from thirst and starvation that would inevitably occur

within 7 to 10 days.

Despite that stark warning, Brian N. refused to have the gastric tube inserted,

stating he wanted to return home and did not “want to die surrounded by strangers.”

He asked the physician to contact his son and daughter-in-law who lived in a nearby

state to help him get home to prepare for his remaining days. Shortly thereafter,

although feeble and disoriented, Brian N. was discharged and returned to his home in

the care of his son. Two days later, Brian N. was unable to move, speak or respond to

verbal requests. His son rushed him back to Jefferson County Hospital and urged the

physicians to insert the gastric tube to “keep him alive as long as possible.” When the

doctors declined to do so relying on Brian N.’s previous statements to them about his

intentions, his son threatened to get a court order to continue treatment. The

hospital’s administrator and physicians asked the hospital ethics review committee for

their recommendation.

As a member of the ethics review committee: (1) what facts or information

would you use or need to know in reaching a determination of Brian N.’s continued

treatment; (2) what recommendation would you make to the hospital administrator?

Your answer must be in writing (1-2 pages) submitted on Blackboard no later

than Wednesday, July 22, 2020 at 5:30 P.M.




Healthcare Management – End of Life Issues

In the case study, there are several areas of consideration to ascertain whether or not it was right for the doctors to refuse the intentions of the family to keep the patient alive as long as possible. As such, it is essential to review the facts to identify the possibility of a right to ‘aid in dying’ and the opportunity that the decision to refuse life-sustaining treatment was a form of assisted suicide (Myers v. Schneiderman, 2017). Furthermore, it is essential to review how legalities influence the role of the family and the health provider. Accordingly, a review of the various interests in the case will reveal whether or not the patient’s decision to be kept out of artificial life supports can get any legal protection (Glenn, 2019). From the case study, Brian had a convincing reason to continue with the euthanasia since there was no other form of treatment that could be effective, and his body organs were deteriorating over time.


Brian had received the diagnosis and understood from professional advice that he suffered a terminal condition. Patient Self Determination Act (PSDA) of 1990 law recognizes the role of the patient in deciding what will happen to their body in the contexts of medical care (Ulrich, 2001). The patient was able to ascertain the effects of the state on their health. For instance, Brian consistently declined the use of a gastric tube. According to the case, he claimed that he wanted to go home and did not want to die around strangers. Process frameworks for supporting the client’s decision power involve communicating with them about their decision-making rights at the admission point (“Ethics in Healthcare”, slide 12). Besides, medical centers also educate their staff on the directives to follow in such cases.


The recommendation to the administrator is to respect the initial decision of the client with sufficient proof that it was part of their will that they finalize their treatment by removing the life support machines. Several legal provisions define whether or not the decision is right. For instance, aid in dying means action by the medical personnel to introduce lethal drugs to the patient that causes death (Cholbi & Varelius, 2015). As such, the medical personnel share in the liabilities emerging from losing the patient. However, the case appears as a refusal to continue treatment, which is declining life support that keeps the patient from dying.

The In re Storar case, Matter of Eichner v Dillon in 1981 New York Court of Appeals, affirmed that the decision for euthanasia by the patient must be clear and with a convincing reason (Matter of Storar, 1981). The implications are that unless the patient was incompetent, they have a right to decide how the hospital should perform their treatment. Withholding of care for competent persons is wrong because the medical personnel does not accurately understand the aim of the patient (Colabrese, 1981).  Therefore, in as much as the patient may require a form of assisted suicide, the physicians are able to decline if the health of the patient makes them competent enough for recovery.


In conclusion, Brian had a convincing reason to continue with the euthanasia since there was no available alternative form of treatment, and his body organs were deteriorating over time. Various legal provisions guide the decision about whether stopping the medicine administration is supported by the Patient Self Determination Act (PSDA) or occurs as assisted suicide or aid in dying. Part of the PSDA provisions is that doctors can perform euthanasia with clear and convincing evidence, such as the case where there are no treatment options. Hospitals should provide patients with information about their rights to decide their treatment options before they recline to an incompetent state. However, patients are informed about their decision-making rights prior to treatment or after diagnosis. With a clear prior intention to end life, it was not wrong for the patient to go through euthanasia if they indicated that as their choice during their competent years or days.


Colabrese, C. A. (1981). In re Storar: The Right to Die and Incompetent Patients. U. Pitt. L. Rev.43, 1087.

Cholbi, M., & Varelius, J. (Eds.). (2015). New Directions in the Ethics of Assisted Suicide and Euthanasia (Vol. 64). Springer.

Glenn, L. M. (2019). A Review of David Lemberg’s Ethical and Legal Issues in Healthcare.

Ethics in Healthcare: End of Life issues. Presentation.

Matter of Storar, 52 N.Y.2d 363, 420 N.E.2d 64, 438 N.Y.S.2d 266 (1981).

Myers v. Schneiderman, 30 N.Y.3d 1, 85 N.E.3d 57, 62 N.Y.S.3d 838 (2017).



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