You are the primary care physician for a 78-year-old man with severe dementia, coronary artery disease, COPD, hyperlipidemia, and HTN. He takes hydrochlorothiazide, lisinopril, metoprolol, aspirin, simvastatin, and tiotropium as well as oxygen at 2 L/minute. The patient no longer recognizes his wife or other family members and requires total care at a nursing home facility. The wife approaches you stating that her husband never wanted to live like this and asks you to stop all of his medications including the oxygen and enroll him in hospice for comfort care. The patient’s living will states that his wife is to make decisions if he becomes incapacitated. The patient’s two grown children object to this plan and ask you to continue all current medications.
What is the appropriate next step?
A. Hold a family conference and explain that you will need to stop all medications and enroll the patient in hospice as per the wife’s expressed wishes as she legally has the power of attorneyThe patient has a valid living will in place that clearly states the wife should make decisions when the patient becomes incapacitated. This living will must be honored. You could do your best to explain to the children why their mother’s decision is not only legally acceptable but ethically acceptable as well. Their father had expressed his wishes, and his current poor quality of life was not something he had wanted to prolong. You could emphasize that no action will be taken to hasten their father’s death and that he will be provided compassionate care until the day he dies naturally. Consulting an ethics committee can be helpful when documentation of the patient’s wishes is unclear. Serving as an advocate for the patient, even when the patient has lost decision-making capacity, is an essential role of the primary care physician. Withdrawal from care in this circumstance is unethical.