HA4050D – Healthcare Law

Discussion 09.2: Living Will

SCENARIO

An elderly male patient with multiple co-morbidities was admitted to your hospital three days ago with

an acute heart problem. Upon his arrival to the emergency room, it was determined he needed to have

a pacemaker implanted to keep his heart in proper rhythm. Due to his unstable condition and other

medical problems, surgery was not an option at that time. Therefore, a temporary external pacemaker

was placed on the patient by the cardiologist to “buy some time” until his medical condition could be

fully assessed and other decisions could be made. The patient continues to be unable to communicate

at this point but has a Living Will, which states he does not wish to be kept alive by artificial means, etc.,

if he is terminally ill or permanently unconscious. The doctors are concerned at this point, because the

longest a temporary pacemaker is supposed to stay in place is 3-4 days due to other complications it

can cause, and needs to be replaced with a permanent pacemaker as soon as possible. However, the

prognosis is not good, and the doctors don’t think he will even survive the surgery—they believe that

the criteria required by the Living Will have been met.

Notwithstanding the Living Will, the patient’s wife and family maintain “he is a fighter” and if the

patient could speak for himself, he would want to take a chance with the surgery. Accordingly, the wife

and family are insisting the cardiologist accept their consent in behalf of the patient for the procedure.

It is noted there is a possibility the patient might be competent enough to communicate if they take

him off of his strong pain medications long enough to get a response from him. However, by doing so,

the patient will then be in a great deal of pain.

DISCUSSION QUESTIONS

. Should the hospital listen to the patient’s wife and remove the pain medications to find out

what the patient’s desires are, or should the hospital invoke the living will? 

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