Who Decides at the End-of-Life?

Near the end of the workday, you get a call from a nurse in the ICU. He’s been asked to call by one of the ICU doctors. They have a patient who is probably terminal and the family don’t agree about withdrawing treatment. Who gets to decide? The nurse, Gabriel Garcia, seems rushed, but you take a moment to ask a couple of questions about the patient and note his Medical Record Number. Aaron Black is a 28-year-old male with a diagnosis of glioblastoma (an aggressive brain cancer). His condition has deteriorated suddenly. Mr. Black is in and out of consciousness. He cannot answer simple questions when he regains consciousness. “Are you in doubt about whether he has capacity to make his own decisions?” They are not. He clearly lacks capacity. “Is there a Power of Attorney?” “There’s nothing on paper. He’s so young—I don’t think they were expecting this.” Your hospital has a policy regarding decisions made for adults who lack decision-making capacity. It...
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Winds of Winter

The health care organization you work for serves a rural population and most staff members commute to work, some for 45 minutes or more, over roads in varying states of repair. The past winter there were several storms that made it challenging for some people to get to work, and the organization found itself short staffed when this happened. In addition, some managers required employees who couldn’t make it in to take the time as a sick day, while others did not. The lack of consistency in practices raised concerns at a leadership level and has resulted in a degree of antagonism between those who live close to the facility and those who live further away. You are part of a policy working group tasked with developing policy around reporting for work in adverse weather conditions. Committee members have significant concerns about justice. In this case, their concerns about justice focus primarily on fair distribution of risk and fair distribution of workload. In...
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