Question 270

Question:

A 95-year-old woman in a nursing home has had advanced vascular dementia, severe dysphagia, and a 9-kg (20-lb) weight loss over the past 2 months. Her four children are divided regarding the decision to provide artificial feeding through a gastrostomy tube. There is no living will. The oldest son approaches the physician after a family meeting and says, “You should simply decide what is best for her and tell the others that’s what we should do.” Assuming the physician proceeds in this manner, which of the following best describes the physician’s action?

Correct Answer: A.  Paternalism

Paternalism is when a physician places his/her values system as the primary values system to make decisions for the care of the patient instead of deferring to the patient’s values or autonomous decisions. In this case, the wishes of the patient should be represented by the family members as there is no living will or advanced directives.

Preserving fairness would involve ethical decisions about who should receive scarce resources; a classic example deals with who should have priority in receiving organ transplants.

A good example of protecting patient autonomy is the process of informed consent before procedures or experiments.

Rationing care acknowledges scarce health resources must be appropriated based on their cost-effectiveness, even though an individual patient’s health options may be diminished.

A good example of truth-telling would involve the disclosure to a patient of his/her prognosis.