1. Should he have been intubated?

Mr. N is currently intubated but by the time his children mentioned his advance

directive, the health team of Mr. N should terminate his intubation procedure. In order to

deliver the best care for Mr. N, healthcare providers should respect his right to autonomy.

As told by his children, he requested that he doesn't want to end his days on a machine.

One of our responsibilities as nurses is to practice the rights of our clients and ensure that

our actions are in their interest and do not cause harm.

2. Can life-support be discontinued in accordance with the patient’s request

expressed directly or communicated to the team by the children?

As Mr. N approaches the terminal phase of his disease, he expressed his wishes about

his end-of-life care ahead of time through his children. Yes, Mr. N’s life-support can be

discontinued based on what he said on his oral advance directive. Through this directive, it

allowed him to express his values and treatment preferences to guide his future decisions

about his health. We, healthcare providers, have respect for our client’s autonomy and

fidelity.

3. How should a care provider respond to the request of Mr. N’s children?

Because of Mr. N’s current state, he cannot speak out his own decision. Instead, his

children act as a surrogate for his healthcare decision which he already mentioned

beforehand. What healthcare providers can do is to document the conversation, including

the patient’s specific preferences regarding interventions in the medical record. There

should be another healthcare provider to act as a witness while the documentation is being

done. It is also our responsibility to inform his children about the possible complications of
his illness and any change in the plan of care before the change is made. Additionally, we

must help them understand how to carry out their father’s wishes including if removing the

life support machine would achieve the patient’s goals for care.

4. What concerns do you have about this decision-making in the absence of AD as

described?

If there is no oral or written advance directive or a health care proxy to guide decisions,

the healthcare team should provide medically appropriate interventions when urgently

needed to meet the patient’s immediate clinical needs. Interventions may be withdrawn at

a later time in keeping with the patient’s preferences when they become known and

following ethics guidance for withdrawing treatment. As long as we work within the ethico-

moral guidelines, do no harm, respect for autonomy, etc., we must continue rendering our

care to patients.