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1)The difference between a coma and a vegetative state is that a person in a deep coma requires hospital care, while a person in a permanent vegetative state can be release to their family for home care. A coma is a deep state of unconsciousness. People in a state of coma are alive but unable to move or respond to their environment. A person in a coma can experience some improvement. The permanent vegetative state is when a patient is unaware of anything in their environment and there is no prospect of any type of change from this state by any means (Wade, 2001).
The legal issue comes in to the situation, when the decision is made for the patient because the patient cannot. Therefore, they can only be treated if it is in their best interests. If there are family members that cannot agree on what the patient would want then it can be referred to the court. The courts can determine whether it is in the best interests of the patient that his life should be prolonged by the continuance of this form of medical treatment or care.Any decision made should be made based on what the patient would want. That can only be determined if the patient has a written directive or living will to state if this situation were to happen how he or she would want it to be handled. A living will express the wishes of the patient and ith the patient would prefer to prolong life or allow them to die.
Wade, D. T. (August 2001). Ethical issues in diagnosis and management of patients in the permanent vegetative state. Retrieved May 01, 2017, from http://www.worldrtd.net/news/ethical-issues-diagnosis-and-management-patients-permanent-vegetative-state
2)Dr. Arenella (2005) defines a coma as a state in which the cortex or higher brain areas of a person are damaged resulting in loss of consciousness, inability to be roused, and unresponsiveness to pain, sound, touch and light. If lower brain centers are damages, a respirator maybe required for the person to breathe. The damage maybe reversible or irreversible… and a permanent vegetative state (PVS) exits when a person is able to be awake, but is totally unaware. A person in this state can no longer “think,” reason, relate meaningfully with his/her environment, recognize the presence of loved ones, or “feel” emotions or discomfort. The higher levels of the brain are no longer functional” (www.americanhospice.org).
The family and caregivers of the patient may have conflicting ideas about the patient well-being and state of health, treatment methods, and also whether the patient is in a PVS or Coma, how long before they pull the plug? What are some of the legal things that they will have to consider before turning off the ventilator? Funeral arrangements, and some may still believe that the patient will pull through and return from a coma, but not a PVS; especially if they patient is in that state for more than a few months, then its permanent or persistent vegetative state. Depends on what state the patient is in, then finance plays a major part; meaning that is the patient going to have healthcare coverage or will the family have to pay out-of-pocket.
The patient’s wishes should take precedent over anyone’s (family, friends, or spouse) decisions providing the has a living will or an Advance Medical Directives signed and notarized which states who should act as a surrogate in the medical decision making for the patient in a coma or PVS. The presence of a living will or AMDs will help guide the care provider in making critical care decisions for the patients. Furthermore, it will help the patient practice his autonomy when he/she gets fatally ill.
Arenella, C. MD (2005). Coma and Persistent Vegetative State: An Exploration of Terms. Retrieved from American Hospice Foundation website: https://americanhospice.org/caregiving/coma-and-persistent-vegetative-state-an-exploration-of-terms/
3)Scenario: You are the hospital administrator and are told by your ICU unit director of a patient in the unit that has suffered serious brain damage, but is not currently meeting the criteria for complete brain death. Half of the family is insisting that the patient "wouldn't want to live this way" and the other half is accusing them of wanting to kill the patient. Some allegations have been raised about a substantial inheritance for some family members upon the patient's death. The battle is becoming intense and it is beginning to disrupt the medical and nursing staff.
1) Write an analysis (1,250-1,500 words) of the situation from an ethical and legal perspective. Address the following questions:
a) What are the ethical issues?
b) What are the legal issues?
c) What are the medical care issues?
d) What actions would you take? Why? How?
e) What resources would you tap?